Algorithm for Treatment of Supernumerary Nasal Tooth.

ABSTRACT: The presence of a tooth in the nasal cavity is a rare condition. There is an even more rare association, which is the presence with the mineral's deposition and formation of rhinoliths. This report shows a case of rare nasal tooth associated with rhinolithiasis and describes its surgical treatment based on an algorithm. The diagnosis was made by endoscopy with the aid of computed tomography, followed by surgical endoscopy excision. The algorithm and the proposed treatment was successful in its execution and the patient presents no complaints or complications at 3 years after surgery.

Traumatic intrusion of maxillary permanent incisors into the nasal cavity: report of a case.

Complete intrusion injuries in the mixed or permanent dentition are relatively rare and represent one of the most serious injuries to the periodontal ligament in dental traumatology. This paper describes the case history of a 7-year-old boy who sustained displacement of central incisors into the nasal cavity. Surgical repositioning was undertaken and a splint was placed.

Clinical and immunohistochemical study of melanotic neuroectodermal tumor of infancy in the maxilla.

Melanotic neuroectodermal tumor of infancy is a rare and fast-growing neoplasm. In this study, we describe the case of a 6-month-old female patient, who presented swelling in the anterior maxilla. Tomographic reconstruction showed an unilocular hypodense and expansive area associated with the upper right central primary incisor. The presumptive diagnoses were dentigerous cyst, adenomatoid odontogenic tumor, melanotic neuroectodermal tumor of infancy and rhabdomyosarcoma, and an incisional biopsy was performed. Microscopically, the lesion revealed a biphasic cell population, consisting of small, ovoid, neuroblastic-like cells and epithelioid cells containing melanin. Immunohistochemically, the melanocyte-like component was strongly and diffusely positive for HMB-45 and Melan-A, but weakly positive for S100. Based on these findings, definitive diagnosis of melanotic neuroectodermal tumor of infancy was established. Then, enucleation of the lesion was performed by careful curettage. After 2 year follow-up, no clinical or radiographical evidence of recurrence was verified. The present case highlights the importance of early diagnosis and therapeutic intervention at the appropriate time to achieve a favorable outcome for the patient.

Spontaneous Eruption of Premolar Associated with a Dentigerous Cyst.

Dentigerous cyst (DC) is the second most common odontogenic cyst with greater incidence in young patients. It presents as a unilocular, asymptomatic radiolucency involving the crown of an impacted tooth, commonly noticed in X-rays to investigate absence, wrong tooth position, or delay in the chronology of eruption. Decompression/marsupialization (D/M) is the most implemented treatment, especially when preserving the tooth involved is advised. The aim of this study is to discuss the DC characteristics that contribute to spontaneous eruption of premolars, by reporting the case of a conservative treatment of DC. This eruption depends on factors such as age, angulation of inclusion, rate of root formation, depth of inclusion, and eruption space. This paper reports the case of a 10-year-old patient with a radiolucent lesion diagnosed as DC involving element 35, which erupted as a result of treatment. The patient was observed during 1 year and 6 months.

Surgical treatment of odontogenic myxoma and facial deformity in the same procedure.

Odontogenic myxoma (OM) is an uncommon benign tumor with aggressive and invasive behavior. Predominant symptoms are usually slow and painless swelling, sometimes resulting in perforation of the cortical borders of the affected bone. In this paper, a case report of a patient with an OM on the right maxillary sinus and a vertical excess of maxilla will be presented. The treatment chosen was tumor resection in association with orthognathic surgery with biomodels assessment for surgical planning. A 3-year follow-up showed disease free and stability of the new position of maxilla. The international literature is evaluated to discuss this case report.

Clinical and immunohistochemical study of melanotic neuroectodermal tumor of infancy in the maxilla / Estudo clínico e imuno-histoquímico de tumor neuroectodérmico melanocítico da infância em maxila

ABSTRACT Melanotic neuroectodermal tumor of infancy is a rare and fast-growing neoplasm. In this study, we describe the case of a 6-month-old female patient, who presented swelling in the anterior maxilla. Tomographic reconstruction showed an unilocular hypodense and expansive area associated with the upper right central primary incisor. The presumptive diagnoses were dentigerous cyst, adenomatoid odontogenic tumor, melanotic neuroectodermal tumor of infancy and rhabdomyosarcoma, and an incisional biopsy was performed. Microscopically, the lesion revealed a biphasic cell population, consisting of small, ovoid, neuroblastic-like cells and epithelioid cells containing melanin. Immunohistochemically, the melanocyte-like component was strongly and diffusely positive for HMB-45 and Melan-A, but weakly positive for S100. Based on these findings, definitive diagnosis of melanotic neuroectodermal tumor of infancy was established. Then, enucleation of the lesion was performed by careful curettage. After 2 year follow-up, no clinical or radiographical evidence of recurrence was verified. The present case highlights the importance of early diagnosis and therapeutic intervention at the appropriate time to achieve a favorable outcome for the patient.

RESUMO O tumor neuroectodérmico melanocítico da infância é uma neoplasia rara e de crescimento rápido. Neste estudo, relata-se o caso de uma paciente do sexo feminino de 6 meses de idade, que apresentou tumefação na região anterior de maxila. A reconstrução tomográfica revelou área unilocular hipodensa e expansiva associada ao incisivo central superior direito decíduo. Realizou-se biópsia incisional, considerando as hipóteses diagnósticas de cisto dentígero, tumor odontogênico adenomatoide, tumor neuroectodérmico melanocítico da infância e rabdomiossarcoma. Microscopicamente, a lesão revelou população celular bifásica, consistindo de células pequenas, ovoides, de aparência neuroblástica, e de células epitelioides, contendo melanina. A análise imuno-histoquímica demonstrou que o componente celular contendo melanina era positivo de forma intensa e difusa para HMB-45 e Melan-A, mas levemente positivo para S100. Com base nestes achados, foi estabelecido o diagnóstico definitivo de tumor neuroectodérmico melanocítico da infância. Em seguida, foi realizada a enucleação da lesão com curetagem cuidadosa. Após 2 anos de acompanhamento, não foram verificadas evidências clínicas ou radiográficas de recorrência. O presente caso destaca a importância do diagnóstico precoce e da intervenção terapêutica no momento apropriado, a fim de alcançar um desfecho favorável para o paciente.

Adenomatoid odontogenic tumor simulating periapical cyst: case report / Tumor odontogênico adenomatóide simulando cisto periapical: relato de caso clínico

ABSTRACT The adenomatoid odontogenic tumor is a benign, non-invasive tumor and has a slow growth. Its preferred location is the anterior maxillary area, most often causing root displacement, more rarely resorption and mostly affects young women. Being asymptomatic, this injury is discovered upon routine radiographic examination, in which, in most cases, a unilocular, radiolucent image is observed and it may have some degree of calcification within the lesion. This work aims to report the case of a 14-year-old patient who attended the Lauro Wanderley University Hospital (UFPB), complaining of increased volume over a period of 8 months, in the region of non-vital tooth 21. The CT scan showed well-delimited unilocular, radiolucent lesion, with buccal cortex resorption. The proposed treatment plan involved enucleation, followed by peripheral ostectomy and bone graft with alloplastic materials. Because of its benign character, encapsulated and slow growing, the treatment of choice for adenomatoid odontogenic tumor is conservative, the surgical enucleation of the injury being advocated. The excised piece was sent for histopathological analysis, where the AOT diagnosis was confirmed. After 7 months, new bone formation was observed without signs of recurrence.

RESUMO O Tumor Odontogênico Adenomatóide é um tumor benigno, não invasivo e de crescimento lento. Acomete principalmente mulheres jovens, na região anterior da maxila, causando na maioria das vezes deslocamento radicular e raramente reabsorção. Por ser assintomática, essa lesão é geralmente descoberta em exames radiográficos de rotina, no qual se observa na maioria dos casos uma imagem radiolúcida unilocular, podendo apresentar algum grau de calcificação no interior da lesão. Este trabalho tem como objetivo relatar o caso clínico de um paciente de 14 anos, gênero feminino, que compareceu ao Hospital Universitário Lauro Wanderley - Universidade Federal da Paraíba, com queixa de aumento de volume de 8 meses de evolução, em região de elemento 21 não vital. Ao exame tomográfico observou-se lesão radiolúcida, unilocular, bem delimitada, com reabsorção da cortical vestibular. O plano de tratamento proposto foi a enucleação seguida de ostectomia periférica e enxerto ósseo com material aloplásico. A análise histopatológica confirmou o diagnóstico de Tumor Odontogênico Adenomatóide. Após sete meses observa-se nova formação óssea e sem sinais de recidiva.

Rehabilitation of severely resorbed edentulous mandible using the modified visor osteotomy technique.

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Brånemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants.

Estudio retrospectivo de 91 cirugías de elevación de seno maxilar para rehabilitación sobre implantes

Los injertos óseos para elevación del piso sinusal han sido utilizados por largo tiempo con buenas tazas de éxito. EL objetivo de esta investigación fue estudiar el comportamiento intraoperatorio y postoperatorio de 91 cirugías consecutivas de elevación de seno maxilar. Fueron seleccionados 72 pacientes de entre 18 y 66 años para realizar el procedimiento con anestesia local o general; se estudiaron variables preoperatorias, intraoperatorias, postoperatorias, instalación de implante y complicaciones de la cirugía. El análisis de datos se realizó con la prueba test de Fisher con p<0,05 para establecer significancia estadística. En el 74,7 por ciento se utilizó hueso autólogo con o sin ayuda de biomaterial, siendo que en 86,8 por ciento se utilizó un sitio donante intrabucal. Se instalaron 101 implantes siendo un 69,3 por ciento instalado en un segundo procedimiento quirúrgico y los restantes 31 implantes instalados en el mismo tiempo quirúrgico de instalación de injerto óseo; no se observó diferencia estadística entre el éxito de los implantes instalados en uno o dos tiempos quirúrgicos (p>0,05); se observo la pérdida de 4 implantes, los cuales no fueron asociados a ningún tipo de material utilizado para el relleno óseo (p>0,05). La principal complicación fue la laceración de membrana, presente en el 18,7 por ciento, postergándose el procedimiento para ser realizado nuevamente en 13 de los 17 casos. Finalmente se puede concluir que la elevación de seno es un procedimiento reconocido y que es viable de presentar y asegurar estabilidad de los implantes instalados para el desarrollo de la oseintegración.

Osseous graft for sinus floor elevation has been used for a long time with good results. The aim of this research was to evaluate the operatory and post operatory characteristic of 91 consecutively surgeries for sinus floor elevation. We selected medical records of 72 patient between 18 and 66 years of age for the treatment with local or general anesthesia. Data analysis was realized with a Fisher test with p<0,05 for statistical significance. In the 74.7 percent autogenous bone with or without biomaterial was used; in 86,8 percent intraoral donor site was used. We installed 101 implants with 69.3 percent installed in the second surgical time and the other 31 implant installed in the same surgical time with the bone graft; we did not observe any statistical relation in the survival of implants installed in surgical times one or two (p>0,05). We observed the loss of 4 implants without relation with the material used for sinus lift (p>0,05). The more common complication was membrane laceration in 18.7 percent, and in 13 of 17 cases with this situation the same surgery was performed at a later time. Finally, it can be concluded that the sinus lift is a recognized and safe procedure showing implant stability for adequate osseointegration.

Rehabilitation of severely resorbed edentulous mandible using the modified visor osteotomy technique

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Brånemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants.

A reabilitação protética de mandíbulas edêntulas muitas vezes torna-se insatisfatória em função da falta de tecido de suporte para reabilitação com implantes osseointegrágeis ou mesmo próteses totais convencionais. A falta de estabilidade protética ocasiona perda de qualidade de vida, pois geralmente resulta em limitação funcional e transtornos sociais. Este artigo descreve um caso clínico de uma paciente de 53 anos que procurou atendimento em nosso serviço queixando-se de dificuldade em mastigação e instabilidade da prótese total inferior, e apresentando atrofia severa de mandíbula. A reabilitação mandibular foi realizada com prótese fixa do tipo protocolo Brånemark, após cirurgia pré-protética reconstrutora com a utilização da osteotomia em "viseira modificada" e enxerto ósseo autógeno. A técnica proposta ofereceu resultados previsíveis para a reconstrução de mandíbulas severamente reabsorvidas para posterior reabilitação com implantes osseointegráveis.

Fibroma cemento-ossificante do maxilar / Cemento-ossifying fibroma of the maxillary

O fibroma cemento-ossificante é uma lesão benigna decrescimento lento que acomete os maxilares, principalmente a região posterior da mandíbula, sendo raramente encontrado em relação com os seios paranasais ou outros ossos da face. Manifesta-se com forte predileção pelo sexo feminino, predominantemente na terceira e quarta décadas de vida e responde favoravelmente ao tratamento cirúrgico que consiste em enucleação total da lesão. Nesse artigo relata-se o caso de um paciente, 15 anos, sexo feminino, melanoderma, com assimetria facial, apresentando ao exame clínico um abaulamento maxilar do lado direito, com deslocamento dentário e ausência de sintomatologia dolorosa. O diagnóstico de fibroma cemento-ossificante foi confirmado por exame anátomo-patológico, recebendo tratamento cirúrgico por enucleação e curetagem. Não foram observados sinais de recidiva após acompanhamento de 36 meses