Glandular odontogenic cyst misdiagnosed and treated as a periapical inflammatory lesion for 6 years in an older adult.

OBJECTIVES: To document the case of a patient who underwent several endodontic treatments due to a glandular odontogenic cyst misdiagnosed as an inflammatory periapical lesion. BACKGROUND: Glandular odontogenic cysts behave more aggressively, while others have an indolent course. There is limited information on this cyst in the gerodontologic literature. MATERIALS AND METHODS: A 76-year-old male patient presented with an asymptomatic expansive lesion in the anterior mandible resistant to several endodontic treatments. Cone-beam computed tomography revealed a multilocular osteolytic lesion measuring 6.0 × 4.0 cm, with cortical bone perforation. RESULTS: Histopathological analysis of a biopsy specimen was consistent with glandular odontogenic cyst. The patient underwent marginal mandibulectomy with preservation of the base of the mandible. CONCLUSION: A strict diagnostic process is important to avoid unwanted consequences, particularly in the geriatric population.

Use of Marsupialization as a Definitive Treatment for Large-sized Dentigerous Cysts in a Patient with Mucopolysaccharidosis Type I.

The correct diagnosis is fundamental for the appropriate treatment to be employed in a particular pathology. The best treatment is not the one that solves only local problems, fragmenting the patient, and therefore, it is necessary to integrate the entire systemic condition of the individual before initiating any local treatment. This context inevitably requires dentistry to participate in a multidisciplinary approach, where the role of the dentist is expanded in concepts that encompass ethics, human dignity, and professional valorization. This article describes a clinical case of a patient with mucopolysaccharidosis type I, whose treatment of cystic lesions present in the mandible was exclusively performed through marsupialisation. The objective of this study is to demonstrate, within the complexity of this rare syndrome, the difficulties of diagnosis and the need for evaluation of the patient beyond the limits of the oral cavity, as well as to report two cases of large dentigerous cysts, surgically treated conservatively through marsupialisation, without the need for re-approach for enucleation and without recurrences over a 20-year period.

Different presentations of the Buccal Bifurcation Cyst: A case series.

The buccal bifurcation cyst (BBC) is an uncommon odontogenic inflammatory cyst affecting the vestibular aspects of the first or second mandibular molar of pediatric patients. Its etiopathogenesis is not fully understood, but it is hypothesized that food and detritus impacting buccal periodontal pockets in titled tooth would be responsible for inflammation of the pericoronal tissues, leading to proliferation of epithelial rests and subsequent cystic formation. The true prevalence of the BBC is not known, but it is estimated to be less than 1% of all the inflammatory cysts. Most cases are unilateral but bilateral cases may account for up to 30% of all BBCs, which can generate confusion to unfamiliar clinicians. Maxillary cases are extremely uncommon, and to our knowledge, there are no cases published in the English literature. In this case series, we present five BBC cases; two unilateral, two bilateral, and one affecting the maxilla. We included clinical, imaging, and histopathological information to highlight the different presentations that this cyst might have, with the final aim to aid clinicians in its diagnosis and ultimately, its treatment.

Non-surgical treatment as an alternative for the management of central giant cell granuloma: a systematic review.

OBJECTIVE: To evaluate the effectiveness of non-surgical treatment as an alternative in the management of central giant cell granuloma (CGCG). MATERIAL AND METHODS: A literature search was carried out in accordance with the PRISMA statement in order to answer the question "Are non-surgical treatments effective as an alternative in the treatment of CGCG?". Two examiners independently assessed eligibility, risk of bias, and extracted data, which included therapeutic protocol, side effects, and need for surgical supplementation. RESULTS: Among 1712 studies, 15 were included, totaling 145 patients. Calcitonin, intralesional corticosteroids, and denosumab were the medications used. For calcitonin (n = 61), complete remission was found in 30 cases. For intralesional triamcinolone (n = 68), reduction in size was observed in most cases (n = 39). Four cases received subcutaneous denosumab and showed absence of active bone metabolism in the region, of which three presented ossification. Combination of drug therapies (n = 29) was reported in one study and included subcutaneous interferon and oral imatinib. More and less side effects were found for interferon and corticosteroids, respectively. Forty percent of patients required additional surgical treatment. CONCLUSION: Despite the side effects presented and the need for additional surgery in some patients, in general, all non-surgical treatments could provide positive results as an alternative for the management of CGCG, especially with regard to reducing the size of the lesion. CLINICAL RELEVANCE: CGCG is a benign bone lesion that mainly affects young individuals. Although the most common therapy is surgery, its contraindication in some patients, the large extension, and high recurrence rate of the aggressive variant have led the search for non-surgical therapies.

Manejo Quirúrgico del Queratoquiste Odontogénico con Invasión al Seno Maxilar: Reporte de Serie Casos y Revisión de la Literatura / Surgical Management of Odontogenic Keratocyst with Invasion of the Maxillary Sinus: Cases Report and Review of the Literature

El queratoquiste odontogénico (QQO) es una quiste intraóseo poco frecuente que varía entre un 3 a 11% de todos los quistes odontogénicos, su ubicación en el maxilar es rara y la invasión al seno maxilar lo es aún más. El QQO es una patología benigna, localmente agresiva que tiene una alta tasa de recidiva. Se han descrito diversas técnicas quirúrgicas para su tratamiento, las cuales van desde lo más conservador como la enucleación a lo más radical como una resección. El uso de agentes coadyuvantes químicos o cauterizantes han logrado disminuir la tasa de recidiva en conjunto con tratamientos más conservadores, disminuyendo la morbilidad y secuelas asociada a una resección. El objetivo de este trabajo es presentar una serie de casos clínicos de QQO que invaden el seno maxilar, su tratamiento de manera conservadora y una revisión de la literatura comparando los diversos tratamientos y su tasa de recidiva.

Odontogenic keratocyst (OC) is a rare intraosseous pathology that varies between 3 % and 11 % of all odontogenic cysts, its location in the maxilla is rare, and invasion of the maxillary sinus is even more so. OC is a benign, locally aggressive pathology that has a high recurrence rate. Various surgical techniques have been described for its treatment, ranging from the most conservative, such as enucleation, to the most radical, such as resection. The use of chemical or cauterizing adjuvant agents has managed to reduce the recurrence rate in conjunction with more conservative treatments, reducing the morbidity and sequelae associated with a resection. The objective of this work is to present a series of clinical cases of OC that invade the maxillary sinus, their treatment being carried out in a conservatively manner, and a review of the literature comparing the various treatments and their recurrence rate.

Odontogenic Keratocyst: eight-Year Follow-Up After Conservative Treatment / Queatoquiste Odontogénico: seguimiento de Ocho Años Después del Tratamiento Conservador

This study aimed to describe the conservative surgical management of odontogenic keratocyst, comparing with clinical and demographic findings in the literature, based on a literature review, using the quality criteria established in the literature for clinical cases and case series. We searched for cases of keratocysts published in four databases. We selected cases of patients followed up at least one year after sugical treatment. We described the case of a patient who was asymptomatic, and the lesion was detected by routine radiographic examination. At the same surgical time, we enucleated the lesion, followed by curettage and drain installation. Currently, there are no signs of disease recurrence. We followed the CARE guidelines (Case Report Guidelines), in this report. Literature review disclosed 27 cases. Keratocyst was frequent in male-adult patients, and the mean follow-up time after surgery was 46.7 ± 28.1 months. The main clinical findings such as association with teeth, location, extension of lesion, and radiographic pattern corroborate the classic pattern of described cases reported by literature with a low general rate of recurrences. In conclusion, conservative treatment was successful for the clinical case described, over an eight-year follow-up. Most of the described studies did not show lesion recurrence after using the conservative surgical treatment. However, we draw attention to the importance of the long follow up period of our case.

El objetivo de este estudio fue describir el tratamiento quirúrgico conservador del queratoquiste odontogénico, obedeciendo las pautas de CARE (Case Report Guidelines). Los hallazgos clínicos y demográficos en la literatura se compararon basándose en una revisión desarrollada a través de los Criterios de calidad establecidos en la literatura para casos clínicos y series de casos, donde se consultaron cuatro bases de datos para la investigación en salud. La lesión encontrada en el paciente del presente estudio fue detectada en un examen radiográfico de rutina, sin manifestaciones clínicas siendo tratada quirúrgicamente con abordaje conservador. El tratamiento con enucleación, curetaje e instalación de drenaje se instituyó al mismo tiempo quirúrgico y, actualmente, no muestra signos de recurrencia de la enfermedad. De los 27 casos utilizados en la revisión, la lesión predominó en pacientes hombres adultos,con un seguimiento medio de 46,7 ± 28,1 después de la cirugía. Los principales hallazgos clínicos como asociación con dientes, localización, patrón radiográfico y lesión extensa, corroboran el patrón clásico de presentación de la enfermedad descrito en el caso reportado. En conclusión, el tratamiento conservador fue exitoso para el caso clínico descrito, durante un seguimiento de ocho años. La mayoría de los estudios revisados no mostraron recurrencias con el tratamiento quirúrgico conservador empleado, sin embargo, se aconseja realizar un seguimiento a largo plazo.

Voluminoso quiste dentígero de mandíbula tratado en dos etapas quirúrgicas informe de caso / Volumoso cisto dentígero de mandíbula tratado em duas etapas cirurgicas - relato de caso / Large dentigerous mandibular cyst treated in two surgical steps. A case report

Resumen El quiste dentígero es una lesión benigna que se origina en el epitelio odontogénico asociado a la corona de un diente incluido. Son radiolúcidos y uniloculares, generalmente asintomáticos y diagnosticados en exámenes de rutina o exámenes radiográficos. Los terceros molares inferiores y los caninos superiores son los dientes más afectados, y esta lesión también ocurre en dientes supernumerarios o asociados a odontomas. De crecimiento lento puede alcanzar dimensiones considerables, provocando deformidad facial, impactación y desplazamiento de dientes y/o estructuras adyacentes. El objetivo de este trabajo es informar un caso clínico de un voluminoso quiste dentígero mandibular, que se trató quirúrgicamente en dos etapas: la primera intervención con fines de biopsia y descompresión de la lesión y la segunda con el objetivo de enuclear la cápsula remanente. De esta forma, fue posible realizar un diagnóstico preciso de la lesión, reducir su tamaño para permitir una enucleación total con un daño mínimo a las estructuras anatómicas circundantes y la preservación de la función neurosensorial. Se realizó el seguimiento del paciente durante un período de 5 años en el posoperatorio, y el caso evolucionó hasta la curación total.

Resumo O cisto dentígero é uma lesão benigna oriunda do epitélio odontogênico associado à coroa de um dente incluso. São radiolúcidos e uniloculares, normalmente assintomáticos e diagnosticados em exames de rotina ou exame radiográfico. Os terceiros molares inferiores e os caninos superiores são os dentes mais acometidos, tendo também ocorrência desta lesão em dentes supranumerários ou associados a odontomas. De crescimento lento pode atingir dimensões consideráveis, causando deformidade facial, impactação e deslocamento de dentes e/ou estruturas adjacentes. O objetivo deste trabalho é relatar um caso clínico de volumoso cisto dentígero mandibular, tratado cirurgicamente em duas etapas: a primeira intervenção com fins de biópsia e descompressão da lesão e uma segunda com intuito de enuclear a capsula rôta. Desta forma pôde-se realizar o diagnostico preciso da lesão, diminuir seu tamanho de forma a permitir a enucleação total com o mínimo de dano as estruturas anatômicas circunvizinhas e a preservação da função neurossensorial. O paciente foi acompanhado por um período de 05 anos no pós operatório, tendo o caso evoluído para a cura total.

Abstract A dentigerous cyst is a benign lesion arising from the odontogenic epithelium associated with the crown of an impacted tooth. They are radiolucent and unilocular, usually asymptomatic and diagnosed in clinical routine or radiographic examinations. The lower third molars and upper canines are the most affected teeth, and the lesion is also associated with odontomas and supernumerary teeth. The cyst is slow-growing but can reach considerable dimensions, causing facial deformity, impaction, and displacement of teeth or adjacent structures. This study aims to report the clinical case of a large mandibular dentigerous cyst treated in two stages: biopsying and decompressing the lesion and enucleating the cyst capsule. It was thus possible to accurately diagnose the lesion, reduce its size to allow for total enucleation with minimal damage to the surrounding anatomical structures, and preserve sensitive function. A five-year follow-up was performed, with full lesion healing.

Queratoquiste Odontogénico en un Paciente con Displasia Cleidocraneal: reporte de un Caso / Odontogenic Keratocyst in a Patient with Cleidocranial Dysplasia: case Report

RESUMEN: La displasia cleidocraneal (DCC), es un trastorno autosómico dominante poco común, que involucra principalmente a los huesos que se osifican por vía membranosa; afectando el cierre de fontanelas craneales y el desarrollo de las clavículas, además de anomalías dentales y vertebrales. El objetivo de este manuscrito fue reportar el caso de una paciente con DCC que presentó un queratoquiste odontogénico (QQO) intrasinusal. Presentamos el caso de una paciente de 81 años, diagnosticada en su niñez con DDC, que consultó por un desajuste protésico y molestias en relación a la zona del seno maxilar derecho. Clínicamente se observó desajuste de la prótesis y aumento de volumen de márgenes poco definidos en la zona maxilar derecha, color rosa coral; que se extendía por todo el margen hemimaxilar derecho hasta el fondo de vestíbulo; doloroso a la palpación, con un mes de evolución. Se solicitó CBCT, con el que se pudo verificar la presencia de un desarrollo tumoral de contenido similar a dentículos, ubicado en la totalidad del seno maxilar derecho; extendiéndose hasta el piso de la cavidad nasal y orbitaria. Se estableció la hipótesis diagnóstica de "odontoma compuesto". Se le intervino quirúrgicamente, bajo anestesia general, realizándose una excisión de la lesión; la que era de márgenes definidos, con cambios de coloración en tonos oscuros, con la inclusión de tres piezas dentarias; de aspecto maligno. Se logró enucleación completa, dejando remanente óseo limpio. La pieza fue enviada a estudio histopatológico. En informe histopatológico, describió la presencia de una lesion quistica con pared compatible con queratoquiste.

ABSTRACT: Cleidocranial dysplasia (CCD) is an uncommon autosomal dominant disorder that mainly involves bones that ossify via the membrane, affecting the closure of cranial fontanels and the development of the clavicles, as well as presenting dental and vertebral anomalies. The aim of this manuscritpt was to report a case of a patient with CCD who presented an intrasinusal odontogenic keratocyst.We present an 81-year-old female patient, diagnosed with this syndrome in childhood, who comes to our service for a prosthetic misalignment and discomfort of the right maxillary sinus area. Clinically, there was a mismatch of the prosthesis and an increase in the volume of undefined margins under it, coral pink color, which extended all over the right hemimaxillary margin to the bottom of the vestibule, painful on palpation, with a one month evolution. A CBCT was requested, which revealed the presence of a tumor development with content similar to denticles, located in the entire right maxillary sinus, extending to the floor of the nasal and orbital cavity. The diagnostic hypothesis of "compound odontoma" was established. The patient was operated on in the central ward, under general anesthesia performing the excisional biopsy of the lesion, which showed changes in coloration in dark tones, with defined edges, with the inclusion of three teeth showing malignancy aspects. Complete enucleation was achieved, leaving tumor-free clean bone remnant. In a histopathological report, the presence of a keratocyst wall was described, which is not very compatible given the appearance of the lesion, the presence of the dental pieces included in it, and the behavior of the lesion.

[Giant cell granuloma in the jaw in a 6-year-old child: A case report]. / Granuloma gigantocelular de mandíbula en un niño de 6 años de edad: Reporte de un caso.

Giant cell granuloma represents a non-odontogenic tumor. It is located inside the endosteum of the jaws (central) or in the periosteum (peripheral). Although it is a benign disease process, it can also be locally destructive. This condition is a slow-growing, asymptomatic lesion that usually affects children and young adults, predominantly females in its peripheral presentation and males in its central presentation. The mandible, the region of the incisors, canines and premolars are more affected. The etiology of the giant cell granuloma still remains to be defined. It has been reported that the origin of this lesion could be triggered by trauma or inflammation and hormonal factors. A 6-year-old patient presents a slow-growing lesion in the tooth extraction's region, two months ago. The treatment is surgical. It is important to have an early diagnosis because of the high local destructive behavior and timely referral because the treatment is surgical.

El granuloma gigantocelular representa un tumor no odontogénico que se localiza por dentro del endostio de los maxilares (central) o en el periostio (periférico). Corresponde al 3-5 % de todas las lesiones benignas de los maxilares. Es más frecuente en niños y adultos jóvenes. Se presenta como un tumor de crecimiento lento y asintomático. Preferentemente, se ubica en la mandíbula, en la región de los incisivos, caninos y premolares. Se informa sobre un paciente de 6 años de edad que, conjuntamente con la extracción del premolar temporario inferior, presentó un tejido granulomatoso de crecimiento lento en la región premolar izquierda. La toma de la biopsia fue demostrativa para granuloma gigantocelular. Se realizó el tratamiento quirúrgico, con buena evolución, sin evidencia de recidiva hasta la actualidad. Es importante el diagnóstico temprano de esta lesión por el alto poder destructivo local que presenta y la derivación oportuna para el tratamiento quirúrgico.

Manejo Quirúrgico de la Hiperplasia Condilar Tipo 2: Reporte de un Caso / Surgical Management of Mandibular Condylar Hyperplasia Type 2: Case Report

RESUMEN: La hiperplasia condilar (HC) es un término genérico de una condición patológica que se utiliza para describir situaciones que causan el crecimiento excesivo y sobredesarrollo del cóndilo mandibular, repercutiendo así también en la mandíbula, es la responsable de alrededor del 50 % de las asimetrías faciales y se presenta con mayor frecuencia entre los 11 y 30 años de edad. Se presenta un caso clínico de una paciente femenina de 21 años de edad que presentaba hiperplasia condilar unilateral izquierda con compensación alveolodentaria. Se realizó condilectomía alta con abordaje endoaural para retirar 5 mm de la parte superior del cóndilo y osteotomía mandibular mediante abordaje intraoral circunvestibular, con disección y preservación del nervio dentario inferior, retirando 8 mm del aspecto inferior de la mandíbula de acuerdo a los requerimientos estéticos. El brindar un tratamiento adecuado a la hiperplasia condilar enfocado a corregir las secuelas tanto funcionales como estéticas es de gran beneficio al paciente ya que le permite mejorar su calidad de vida, el correcto diagnóstico es vital para poder planear un tratamiento exitoso.

ABSTRACT: Condylar hyperplasia (CH) is a generic term for a pathological situation that is used to describe conditions that cause excessive growth and overdevelopment of the mandibular condyle and also impacting on the jaw, this bone formation is responsible about of 50 % of all deformities facial and it occurs most frequently between 11-30 years old. This case report is about a 21-years old female who showed unilateral condylar hyperplasia of left side with alveolodentary compensatory. Was carried out high condilectomy through an endoaural approach removing 5 mm of the upper condyle and the mandibular osteotomy was performed through intraoral approach with dissection and preservation of the inferior alveolar nerve, removing 8 mm of the inferior aspect of the mandible according to the aesthetic requirements. An appropriate treatment for the condylar hyperplasia focused on correcting the side effects such as functional or aesthetic it's of great benefit for the patient because it allows improve their quality of life. A correct diagnosis is very important to planning a successful treatment.

Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis.

PURPOSE: This study was conducted in order to determine whether marsupialization before definitive enucleation of nonsyndromic odontogenic keratocysts (OKCs) is capable of decreasing the recurrence rate more effectively than just enucleation. METHODS: We searched MEDLINE, Web of Science, Scopus, and Cochrane Library, until August 5th of 2017 for original studies reporting on the treatment of OKCs with and without previous marsupialization and the related recurrence rate. All records and data were independently assessed, meta-analysis was performed, and the odds ratio of recurrence was the effect measure; P value for the summary effect of < 0.05 was considered statistically significant. RESULTS: The 748 records retrieved were reduced to 6 studies to be qualitatively assessed and 5 studies were included in the meta-analysis. The overall odds ratio of 0.57 [0.25-1.28] of the pooled values pointed that marsupialization reduced the recurrence rate in comparison to just enucleation; however, the P value showed that there is no strong evidence to support this statement. CONCLUSIONS: Marsupialization followed by enucleation after 12 to 18 months reduces the recurrence rate, but more studies are necessary to support this statement.

Cisto ósseo solitário em mandíbula: relato de caso clínico / Solitary bone cyst of the mandible: clinical case report

Objetivo: apresentar um caso clínico de paciente com cisto ósseo solitário em mandíbula e sua evolução após o tratamento de exploração e curetagem cirúrgica por meio de achados radiográficos. Caso clínico: paciente do sexo masculino, 45 anos, compareceu à clínica da Faculdade de Estudos Administrativos ­ Fead. Ao exame clínico, os tecidos se apresentavam dentro dos padrões de normalidade e ao exame radiográfico observou-se área radiolúcida unilocular, limites regulares e bem definidos em região anterior de mandíbula entre ápices dos dentes 33, 32, 31, 41 e 42, sem deslocamento desses. Para confirmação do diagnóstico, além do exame clínico, foi necessário realizar a tomografia de feixe cônico e exploração cirúrgica. Após a exploração cirúrgica foi realizada a curetagem das paredes ósseas e a proservação do caso para acompanhar a sua evolução. Considerações finais: por ser uma lesão de comportamento não agressivo, responde bem a este tipo de tratamento, sendo notável sua melhora durante o período de acompanhamento.(AU)

Objective: To present a clinical case report of a patient with solitary bone cyst of the mandible and its evolution after exploration and surgical curettage treatment through radiographic findings. Case report: A 45-year-old male patient attended the clinic of the School of Administrative Studies - FEAD. The clinical examination showed normal tissues and the radiographic examination showed unilocular radiolucent area and regular and well-defined boundaries in the anterior mandible between the apexes of teeth 33, 32, 31, 41, and 42, without displacement. To confirm the diagnosis, in addition to the clinical examination, cone beam tomography and surgical exploration were required. After the surgical exploration, bone wall curettage and case proservation were performed to monitor the evolution. Final considerations: Considering it is a non-aggressive lesion, it responds well to this type of treatment, with considerable improvement during follow-up.(AU)

Osteomielíte fibrosante bacteriana mandibular em felino / Bacterial fibrous osteomyelitis of the mandible in feline

A osteomielite fibrosante é um processo inflamatório crônico, acompanhado pela destruição e substituição do tecido ósseo por fibroblastos, causado por um microorganismo infectante. Seu diagnóstico é baseado na história, achados radiográficos, histopatologia, cultura e antibiograma. O objetivo do presente estudo foi descrever um caso de osteomielite bacteriana crônica em felino doméstico (Felis catus) na região da mandíbula, acompanhado de osteólise. Após o exame, foi confirmado o diagnóstico de osteomielite fibrosante causada pela bactéria Pseudomonas aeruginosa. O tratamento de escolha foi hemimandibulectomia da porção afetada associada à antibioticoterapia. A pacientea presentou boa recuperação pós-operatória, concluindo que a técnica cirúrgica associada ao uso de antibióticos sensíveis às bactérias mostrou-se eficiente na resolução.(AU)

Firming osteomyelitis is a chronic inflammatory process, accompanied by destruction and replacement of bone tissue by fibroblasts, caused by an infecting microorganism. Its diagnosis is based on history, radiographic findings, histopathology, culture and antibiogram. The aim of the present study was to describe a case of chronic bacterial osteomyelitis in domestic feline (Felis catus) in the mandible region, accompanied byosteolysis. After examination, the diagnosis of fibrosing osteomyelitis caused by the bacterium Pseudomonas aeruginosa was confirmed. The treatment of choice was hemimandibulectomy of the affected portion associated with antibiotic therapy. The patient had a good postoperative recovery, thus concluding that the surgical technique associated with the use of bacteria-sensitive antibiotics proved to be efficient in resolving.(AU)

Tratamento cirúrgico da limitação de abertura bucal causada por hiperplasia do processo coronoide: relato de caso / Surgical treatment for mouth opening limitation caused by coronoid process hyperplasia: case report

A hiperplasia do processo coronoide é uma condiçãoincomum de etiologia desconhecida que se apresentaclinicamente por meio da limitação de abertura bucal enão possui sintomatologia dolorosa durante a aberturae o fechamento bucal. Objetivo: relatar e discutir, pormeio de um caso cirúrgico, o tratamento da limitaçãode abertura bucal causada por hiperplasia bilateral doprocesso coronoide. Relato de caso: paciente do sexofeminino, com 11 anos de idade, foi encaminhada paraatendimento devido à dificuldade de mastigação emfunção da limitação de abertura bucal, sem históricode trauma em face ou na região articular. O exame tomográficoevidenciou o alongamento bilateral do processocoronoide, fazendo com que ele colidisse com oarco zigomático durante a abertura bucal e causasse otravamento. O tratamento proposto foi a coronoidectomiabilateral com acesso cirúrgico intraoral, obtendono pós-cirúrgico imediato um ganho na abertura bucal.Considerações finais: a coronoidectomia é uma abordagemcirúrgica de fácil acesso por via intraoral, poucotraumática e eficaz no tratamento de pacientes com hiperplasiado processo coronoide. (AU)

The coronoid process hyperplasia is an unusual condition of unknown etiology that is presented clinically through mouth opening limitation, without painful symptoms during mouth opening and closure. Objective: to report and discuss, through a surgical case, the treatment of mouth opening limitation caused by bilateral coronoid process hyperplasia. Case report: female patient, 11 years old, referred due to chewing difficulty by mouth opening limitation. No history of trauma in the face or joint area. The tomographic examination showed the bilateral elongation of the coronoid process, causing it to collide with the zygomatic arch during mouth opening, which caused locking. The treatment proposed was bilateral coronoidectomy with intraoral surgical access, which enhanced mouth opening at the immediate postoperative period. Final considerations: coronoidectomy is a surgical approach with easy intraoral access, non-traumatic, and effective in the treatment of patients with coronoid process hyperplasia. (AU)

The use of platelet-rich fibrin as a hemostatic material in oral soft tissues.

The control of postoperative bleeding represents one of the main intercurrent events associated with soft tissue surgical procedures in the oral cavity. In this context, platelet-rich fibrin (PRF) membranes are materials with great potential for optimizing soft tissue healing and induction of hemostasis. This interventional case series describes the treatment of 10 patients with excisional biopsy of benign oral cavity lesions, following a screening sequence at the surgery clinic of a Brazilian dental school between the years of 2015 and 2017. After treatment with PRF, patients presented mean time for postoperative hemostasis of 10.3 ± 2.5 s, requiring the average use of three membranes to cover the surgical area. The results suggest that the use of platelet-rich fibrin membranes may represent a feasible alternative hemostatic material for the treatment of oral lesions.

Expansive renal osteitis fibrosa: a case report.

Hyperparathyroidism (HPT) is an endocrine metabolic disorder characterized by increased secretion of parathyroid hormone. Untreated secondary HPT leads to renal osteodystrophy (ROD). Facial skeletal abnormalities in patients with ROD are rare. The purpose of this paper is to report a conservative surgical approach of exuberant osteitis fibrosa lesions in patient with chronic kidney disease. A 24-year-old female was referred to maxillofacial surgery department with giants ROD affecting palate, maxilla, and mandible, resulting in esthetic and functional impairment. The pathogeneses and multidisciplinary management of ROD are discussed with a brief literature review. Eight years after the conservative treatment of exuberant jaw lesions, no noticeable bone changes were observed in the patient. A multidisciplinary therapy is essential for correct diagnosis of ROD and optimal multimodality treatment. The conservative management was an efficient alternative for the success of the case reported.

Bilateral hyperplasia of the coronoid process: clinical case report with unusual presentation and literary review

The formation of a new joint between a pathologically enlarged coronoid process and the body of the malar bone is known as Jacob's disease. hyperplasia of the coronoid process was first described in 1853 by von Langenbeck, and it was not until 1899 when Oscar Jacob described the disease that was named after him. Jacob's disease is an uncommon entity with only a few cases documented in the literature. the condition manifests at first with progressive limitation of the oral opening and facial asymmetry. the pain is infrequent and mainly affects young patients. temporal muscle hyperactivity, cranial trauma, chronic displacement of the ipsilateral temporomandibular joint, endocrine stimuli and genetic alterations have been postulated as possible factors. the definitive diagnosis is by histopathology and it is necessary that bone hyperplasia is confirmed, as well as the presence of cartilage and synovial capsule forming the new joint between the malar bone and the coronoid process. we present a 10-year-old patient with a history of childhood trauma in the left preauricular region. it presented to our service with a history of progressive limitation of the oral opening. computed tomography (CT) revealed an elongation of the bilateral coronoid process, in contact with homolateral zygomatic bone, causing its deformation. surgery under general anesthesia was performed through the intraoral vestibular route. histopathology confirmed the diagnosis of Jacob's disease. we review the literature regarding the etiology, pathogenesis, clinical characteristics, diagnosis and treatment of this condition.

Chronic Suppurative Osteomyelitis of the Mandible Treated with Antibiotics Complemented with Surgical Treatment: A Case Report / Osteomielitis Crónica Supurativa en Mandíbula Tratada con Antibióticos y Cirugía: Reporte de Caso

ABSTRACT: Osteomyelitis is an infection that affects bone and bone marrow, it occurs due to inoculation of microorganisms either directly or by continuous accumulation through a hematogenous way. Female patient, 64 years old, presenting an increase of volume of the parotid masseteric region and right submandibular region, with approximately two weeks of evolution, which had a slightly fluctuating, hyperemic and hyperthermic indurated consistency; the patient complained of severe pain. CT scan and biopsy was indicated. It is imperative to identify the causative agent; the use of antibiotics must be complemented by surgical treatment to eliminate the possibility of a remaining infection.

RESUMEN: La osteomielitis es un proceso infeccioso que afecta al hueso y medula ósea y que se produce debido a la inoculación de microorganismos ya sea de manera directa, por continuidad o bien por medio de la vía hematógena. Paciente femenino de 64 años de edad que presentaba aumento de volumen en región submandibular derecha refiriendo dolor intenso con evolución de 2 semanas aproximadamente, el cual era de consistencia indurada ligeramente fluctuante, hiperémico e hipertérmico; la paciente se quejaba de dolor intenso, se indicó TC y biopsia. En estos casos para tener éxito en el tratamiento el uso de antibióticos debe complementarse con desbridamiento quirúrgico, aunado a un seguimiento estrecho para descartar la posibilidad de una infección remanente.