Does BRAF V600E mutation affect recurrence rate of ameloblastomas? Systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review with meta-analysis was to critically evaluate the available data on the association of the BRAF V600E mutation and recurrence rate of ameloblastomas. MATERIALS AND METHODS: This systematic review was registered in Prospero (CRD42020183645) and performed based on the PRISMA statement. A comprehensive search in PubMed, Web of Science, Scopus and Cochrane Library databases was performed in order to answer the question "Does BRAF V600E mutation affect recurrence rate of ameloblastomas?" Methodological quality and risk of bias of the selected studies were assessed with JBI Critical Appraise Tool. Meta-analysis of quantitative data was conducted with RevMan 5.3 and Jamovi 2.3. RESULTS: The initial search identified 302 articles, and 21 met the inclusion criteria. A total of 855 subjects with ameloblastoma were included in the analysis. The pooled measures for frequency of BRAF V600E mutation was 65.30% (95% CI: 0.56-0.75; p < .001; I2 = 90.85%; τ = 0.205; p < .001), and the pooled recurrence rate was 25.30% (95% CI: 0.19-0.31; p < .001; I2 = 79.44%; τ = 0.118; p < .001). No differences in recurrence rate were observed between the BRAF V600E and wild type BRAF ameloblastomas, with a pooled Odds Ratio of 0.93 (95% CI: 0.56-1.54; p = .78; I2 = 31%; p = .09). CONCLUSIONS: BRAF V600E mutation is a frequent event in ameloblastomas, but does not increase nor reduce its recurrence rate, and thus have a limited value in predicting its prognosis.

Is the injection of tramadol effective at control of pain after impacted mandibular third molar extractions? A systematic review and meta-analysis

Background: Third molar extraction is among the most common surgical procedures performed by oral-maxillofacial surgeons. Postoperative pain, swelling and trismus are common, especially in wisdom teeth, due to trauma to local tissues and the duration of the surgical procedure, among other factors. Material and methods: This systematic review was conducted in accordance with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' in order to answer the focused question: 'Is the local submucosal injection of tramadol effective at the control of postoperative pain in patients submitted to impacted mandibular third molar extractions?'. We analyzed papers published until March 30, 2021 in the MEDLINE|PubMed, Web of Science and Cochrane Library databases. Gray literature was also consulted. Standard pairwise meta-analyses of direct comparisons were performed using a fixed-effect model; I2 ≥ 50 % or ≥ 75 % indicated moderate or high heterogeneity, respectively. Risk of bias was assessed by Cochrane Collaboration's tool. Results: In total, 172 participants (98 males and 74 females, aged 18 or over) from three randomized placebo-controlled trials were considered for analysis. The submucosal injection of 2 ml of tramadol adjacent to the impacted mandibular third molar was effective in controlling pain up to 6-hours after surgery, in increasing the onset of consumption of rescue analgesic and in reducing the total number of rescue analgesics used. Conclusions: The submucosal injection of tramadol can be considered a safe and effective procedure for pain control after impacted mandibular third molar extractions. (AU)

Complications associated with submental liposuction: a scoping review

Background: Liposuction is one of the most commonly performed cosmetic procedures worldwide. Complications associated with submental liposuction are rare. However, when they occur they are significant and can cause disFiguring consequences. The objective of this study was evaluated complications from submentual liposuction in literature and description of clinical experience of complication after submentual liposuction. Material and Methods: At first, a scoping review was carried out online search with no time restrictions for complications after submental liposuction was performed in the databases Medline / PubMed, Embase, and Web of Science. The variables analyzed were: age, sex, type of esthetic procedure, anesthesia, complications, time after Procedure, treatment, follow-up care, and sequelae. Then, a case of a patient with submental hematoma after an aesthetic procedure for submental liposuction was described. Results: Firstly, 539 articles were selected, after application of the inclusion criteria, 4 studies were included. Most cases were female (8:1), with a mean age of 55.77 years. Postoperative complications were found, such as submental depression, submental edema, hypertrophic scar formation, scar contracture, cervical necrotizing fasciitis, Cervico-facial dystonia and transient facial nerve paralysis. The follow-up period for cases ranged from 3 to 12 months. The clinical case presented there was no sequelae. Conclusions: Submental liposuction requires the surgeon's attention. Anatomical knowledge, correct clinical and surgical management, diagnosis, and immediate approach to adverse situations are points that must be respected in this type of esthetic procedure to avoid more serious complications.(AU)

Ressecção segmentar de granuloma central de células gigantes: relato de caso / Segmentation of central giant cell granuloma: case report

O Granuloma central de células gigantes é próprio dos ossos gnáticos, sendo um tumor benigno não odontogênico. É uma lesão de crescimento normalmente lento, bem circunscrito e assintomático, geralmente diagnosticado através de algum exame de rotina ou, em casos mais avançados, quando se começa a visualizar alguma alteração estético-anatômica. O tratamento de eleição para este tipo de lesão é a simples curetagem ou a ressecção em bloco. No entanto, em pacientes adultos jovens e em crianças, o efeito mutilante que este tipo de tratamento pode acarretar deve ser levado em consideração, utilizando tratamentos não cirúrgicos, como injeção intralesional de corticosteroides, administração de interferon alpha e calcitonina. Assim, o objetivo deste trabalho é relatar um caso de tratamento com ressecção segmentar de granuloma central de células gigantes. Tumores mais agressivos e recorrentes devem ser submetidos à ressecção e mesmo assim deve se levar em consideração o efeito estético que pode causar na face do paciente, principalmente, se forem crianças e adultos jovens... (AU)

The central granuloma of giant cells is specific to gnathic bones, being a benign non-odontogenic tumor. It's a growth injury usually slow, well circumscribed and asymptomatic, usually diagnosed through some routine examination or, in more advanced cases, when it begins to visualize some aesthetic-an atomical alteration. The treatment of choice for this type of injury is a simple curettage or resection in block. However, in young adult patients and children, the mutilating effect that this type of treatment can bring must be taken in to consideration, using non-surgical treatments, such as intralesional injection of corticosteroids, administration of alpha interferon and calcitonin. Therefore, the objective of this work is to report a case of treatment with resection segment of central granuloma of giant cells. More aggressive and recurrent tumors must be submitted to resection and even then taking into account the aesthetic effect it can have on the patient's face, especially if they are children and young adults... (AU)

Reconstrução mandibular com enxerto livre de crista ilíaca: relato de caso / Mandibular reconstruction with iliac crest free graft: case report

Os defeitos ósseos nos maxilares podem ser causados por patologias como ameloblastoma, carcinoma de células escamosas e sarcomas, bem como, por traumatismos faciais que vão desde acidentes de trânsito a agressões por arma de fogo. As reconstruções de tais defeitos ósseos não deverão apenas devolver a anatomia e contorno da região, mas também, restabelecer a estética e função. A escolha do melhor tipo de enxerto para reconstrução mandibular deverá ser feita de acordo com a característica do defeito e, principalmente, a observação do seu tamanho. O presente trabalho relata o caso clínico de um paciente que procurou o serviço de CTBMF do Hospital da Restauração, queixando-se de deformidade em terço inferior de face após agressão por projétil de arma de fogo (PAF) há, aproximadamente, 2 anos. Ao exame físico apresentava perda de continuidade óssea em região de parassínfise mandibular direita, oclusão pouco funcional e com prometimento funcional. Para o caso foi proposta cirurgia para reconstrução do defeito mandibular com enxerto livre de crista ilíaca. Diante disso, um diagnóstico preciso, planejamento minucioso e boa execução da técnica de reconstrução mandibular com enxerto livre de crista ilíaca proporcionam resultados estéticos satisfatórios, contorno e volume ósseos adequados possibilitando um restabelecimento funcional da área receptora... (AU)

Bone defects in the jaws can be caused by pathologies such as ameloblastoma, squamous cell carcinoma, and sarcomas, as well as facial trauma ranging from traffic accidents to gunshot wounds. Reconstructions of such bone defects should not only restore the anatomy and contour of the region, but also restore aesthetics and function. The choice of the best graft type for mandibular reconstruction should be made according to the characteristic of the defect and, especially, the observation of its size. The present study reports the clinical case of a patient who sought the CTBMF service of the Hospital da Restauração, complaining of deformity in the lower third of the face after aggression by FAP for approximately 2 years. Physical examination showed loss of bone segment in a region of right mandibular paresis, malocclusion and functional impairment. For the case, surgery was proposed to reconstruct the mandibular defect with free iliac crest graft. Therefore, a precise diagnosis, careful planning and good execution of the mandibular reconstruction technique with free iliac crest graft provide satisfactory aesthetic results, adequate bone contour and volume allowing a functional reestablishment of the receiver area... (AU)

Surgical Management of Odontogenic Infection in Sturge-Weber Syndrome: Report of a Case.

ABSTRACT: Surgical management of odontogenic infections in Sturge-Weber Syndrome is challenging, due to the risk of massive bleeding and difficulty to achieve hemostasis. The authors describe the use of preoperative vascular embolization for oral surgery in a 29-year-old patient. The authors highlight the importance of hemostatic agents and primary wound closure and the role of vascular embolization as a potential tool for preventing hemorrhage in these cases.

Reconstruction of Posttraumatic Nasal Defect Through Paramedian Frontal Flap.

ABSTRACT: Facial injuries caused by motorcycle accidents represent a challenge for reconstructions. Currently, the most indicated treatment for facial fractures is anatomical reduction and internal fixation, however, this procedure is not exempt from complications, such as infection and exposure of osteosynthesis material, thus requiring a new surgical procedure and repair. In this study, the authors describe a case of a 60-year-old woman who was the victim of a motorcycle accident and developed exposure of osteosynthesis material on the nasal dorsum after treatment of facial fractures. The patient underwent surgical treatment with objective of removing the osteosynthesis material and associated infected tissue, as well as reconstruction using a paramedian frontal flap, which resulted in a harmonic relationship and skin color similar to the recipient area. This case shows the importance of anatomical knowledge and reconstructive techniques for hard and soft tissues.

Management of chronic suppurative osteomyelitis in a patient with pycnodysostosis.

Pycnodysostosis is a rare bone dysplasia that causes changes in the facial skeleton. Osteomyelitis is common in patients with this syndrome, and, among the gnathic bones, the mandible is the most commonly affected. This case report describes the treatment of a 46-year-old woman with pycnodysostosis that was associated with chronic suppurative osteomyelitis of 5 years' duration. The patient had no intraoral focus of infection or history of tooth extraction that would explain the clinical findings of pain and a left-sided submandibular fistula. After the patient received 8 days of antibiotic therapy consisting of ceftriaxone and metronidazole, surgical access was achieved through the left submandibular region, and biopsy and curettage of the lesion and excision of the associated fistula were performed. At the 2-year follow-up examination, there was no evidence of lesion recurrence.

Surgical Management of Gunshot Injury to the Temporomandibular Joint.

One of the indications of the surgical approach of the temporomandibular joint is the presence of foreign body in its interior. However, joint handling offers risks, especially bleeding. In these cases, angiography and embolization of the arteries involved with the projectile play an important role in the prevention of complications. In this report, the authors describe a case of a 23-year-old male victim of firearm attack with comminuted fracture of the right mandibular condyle. The patient underwent angiography and prophylactic embolization of the arteries adjacent to the foreign body. A surgical procedure was performed to remove the projectile and bone fragments with the aid of the X-ray image intensifier, which resulted in the restoration of mandibular function, absence of joint pain, and satisfactory dental occlusion. This case shows the importance of auxiliary imaging methods for performing a safe surgical procedure for removal of ballistic and bony fragments from the interior of the temporomandibular joint.