Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report.

Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry.

Surgical Treatment of Posttraumatic Laterognathia: A Case Report and a Literature Review, Focused on the Effects of a Condylar Fracture on the Face.

Facial asymmetry, following early childhood condylar trauma, is a common complaint among patients who seek surgical treatment. G.D.M., a 27-year-old male patient, sought professional help to correct his cosmetic flaw, caused by a condylar fracture when he was 8-years-old. After the proper orthodontic treatment, he underwent a double jaw orthognathic surgery and, 9 months later, a second one to correct the remaining asymmetry. Two years after this second procedure, the patient is still under surveillance and has no complaints.

Papillary cystadenocarcinoma: report of a case of high-grade histopathologic malignancy.

Papillary cystadenocarcinoma is an extremely rare malignant tumor of the salivary gland which is cytologically considered to be of low-grade malignancy, showing an indolent biological behavior. Histologically, the tumor is characterized by cysts and papillary endocystic projections. This tumor most commonly arises in the major salivary glands, mainly the parotid gland. We report here a case of papillary cystadenocarcinoma originating from the minor salivary gland, which showed marked growth over a short period of time. Histologically, the tumor was characterized by intense cellular and nuclear pleomorphism and numerous mitotic figures. These findings indicate a tumor of high-grade malignancy.

Participation of hMLH1, p63, and MDM2 proteins in the pathogenesis of syndromic and nonsyndromic keratocystic odontogenic tumors.

OBJECTIVES: To evaluate the expression of hMLH1, p63, and MDM2 in Gorlin syndrome-associated keratocystic odontogenic tumors (SKOTs) and nonsyndromic keratocystic odontogenic tumors (NSKOTs). STUDY DESIGN: Seventeen primary NSKOTs, 17 SKOTs, and 8 recurrent NSKOTs were analyzed by using immunohistochemistry. RESULTS: No significant differences in the hMLH1, p63, or MDM2 labeling indices were observed between groups (P = .398; P = .232; P = .426, respectively). Higher hMLH1 immunoexpression was found in the basal layer of primary NSKOTs. Most KOTs exhibited p63 immunoexpression in the upper layers of the epithelium. MDM2 immunoexpression was observed in the upper epithelial layers of SKOTs and recurrent NSKOTs. CONCLUSION: It was not possible to correlate the immunoexpression of hMLH1, p63, and MDM2 in SKOTs and primary and recurrent NSKOTs, suggesting that these proteins exert independent effects on the development of these groups of tumors.

Dupla mandibulotomia com preservação do feixe vásculo-nervoso alveolar inferior para acesso a tumores do espaço parafaríngeo / Double mandibular osteotomy with inferior alveolar neurovascular bundle preservation for improved access to tumors of the parapharyngeal space

Introdução: O acesso cirúrgico ao espaço parafaríngeo para aressecção de tumores apresenta grande dificuldade, uma vezque à medida que se avança superiormente nesta região háuma restrição espacial pela presença do ramo mandibular e doprocesso mastoide do osso temporal. Objetivo: Descrever, atravésda experiência de três casos, a técnica de dupla mandibulotomia,quando um acesso mais amplo é necessário para a ressecçãode neoplasias do espaço parafaríngeo. Método: A técnicautilizada consiste de uma osteotomia na região parassinfisáriacombinada a uma osteotomia no ramo ascendente da mandíbula,o que permite que o segmento contendo o corpo mandibularseja rotacionado para fora do campo operatório, preservando ofeixe vásculonervoso alveolar inferior. Após a ressecção tumoral,é realizada a redução e fixação interna rígida do segmento.Resultados: O uso das duas osteotomias permite não apenasum acesso mais amplo, mas também a proteção ao feixe vásculonervosoalveolar inferior, o qual permanece contido no segmentomandibular osteotomizado e mobilizado. Conclusão: A utilizaçãodesta técnica dispensa o uso do bloqueio maxilomandibulare proporciona ao paciente retornar à função mastigatória deforma precoce no pós-operatório, assim como a permanênciada vitalidade do feixe vásculonervoso alveolar inferior, sem aocorrência de hipoestesia no pós-operatório.