Brown tumor of secondary hyperparathyroidism: surgical approach and clinical outcome.

BACKGROUND: Secondary hyperparathyroidism is a frequent complication of chronic renal failure. The brown tumor is an unusual presentation of fibrous osteitis that represents a serious complication of renal osteodystrophy, affecting predominantly the hands, feet, skull, and facial bones. CASE REPORT: The aim of this paper is to describe the case of a 53-year-old female patient, with renal failure who has been on dialysis for 6 years and developed severe secondary hyperparathyroidism and brown tumor of the maxilla and mandible, confirmed by incisional biopsy. Parathyroidectomy was indicated as a result of rapid growth of the tumor and the maintenance of laboratory findings. Despite the normalization of serum parathyroid hormone and alkaline phosphatase, tumor regression was slow and patient's important functional and esthetic deficits persisted. Excision of the mandible tumor was conservative. Osteoplasty was recommended because during a 5-year follow-up there was regression of the lesion, decreased pain, bleeding, and tooth mobility.

Surgical management of multiple myeloma in the mandible: a case report.

Multiple myeloma (MM), solitary bone plasmacytoma, and extramedullary plasmacytoma are different types of plasma cell neoplasia, which is a lymphoid neoplastic proliferation of ß-cells. While MM is most frequently seen in the vertebrae and long bones, 30% of MM cases are found in the jaws. This case report presents a 58-year-old man with mandibular swelling; his medical history indicated he had a fracture of the humerus 1 month earlier. Panoramic radiography revealed a radiolucent lesion in the mandibular posterior region. Biopsy was performed and the histopathological examination indicated plasmocytoma. However, given the patient's dental and medical history, and the presence of multiple osteolytic lesions, the final diagnosis was MM. The patient underwent chemotherapy for the MM. To treat the pathological fracture of the jaw, a hemimandibulectomy was followed by the installation of a reconstructive plate.

Snake bite envenomation in tongue.

Snake bite envenomation has considerable medical importance because of its frequency and severity. An updated standardization of diagnosis and treatment conduct is essential. At no time did the patient develop respiratory insufficiency, neurotoxicity, or renal failure. Tongue damage rapidly resolved after early and aggressive treatment. The preserved tongue remained well perfused and viable, and tongue mobility was good. The aim of the present study was to describe a rare case of snake bite envenomation in the tongue, emphasizing risk factors, the patient's clinical evolution, and the importance of early, multidisciplinary treatment.

Cervicofacial necrotizing fasciitis following periodontal abscess.

Soft tissue infections are characterized by acute inflammation, diffuse edema, and suppuration, and are often associated with symptoms such as malaise, fever, tachycardia, and chills. Necrotizing fasciitis is a destructive bacterial infection affecting subcutaneous tissue and superficial fascia and is associated with high rates of mortality. It usually involves the abdomen and extremities, but it also can occur in the head and neck. Early diagnosis is critical and the most commonly accepted treatment includes radical surgical intervention and administration of broad-spectrum antibiotics. This article reports and discusses the case of a patient with odontogenic cervicofacial necrotizing fasciitis, and emphasizes the importance of early and effective treatment.

Mandibular desmoplastic ameloblastoma: case report.

Desmoplastic ameloblastoma (DA) is a tumor characterized by unique clinical, radiological, and histopathologic features, mostly an abundance of densely collagenous stroma with small nests and islands of odontogenic epithelium. Due to its aggressive, highly invasive nature, there is a tendency to treat DA with bone resection. This article reports and discusses an uncommon case of mandibular DA, focusing on the importance of early, effective treatment.

Giant sialocele following facial trauma.

Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

Giant sialocele following facial trauma

Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

Lesões na região parotídea e massetérica podem causar danos importantes secundariamente à injúrias de estruturas anatômicas nobres. A sialocele é observada como um aumento de volume facial associado a ruptura do ducto parotídeo devido a trauma. O objetivo deste artigo é relatar um caso de sialocele parotídea gigante traumática, por arma branca, em uma paciente de 40 anos de idade. Em virtude do insucesso de medidas conservadoras de tratamento, uma intervenção cirúrgica por meio de instalação de um dreno à vácuo foi proposta. Sob anestesia local, uma pequena incisão foi realizada adjacente ao ducto da papila parotídea, seguida de divulsão do plano muscular e drenagem de quantidade significativa de saliva. Um dreno à vácuo foi instalado e mantido por 15 dias objetivando formar um novo ducto salivar. Esta técnica se mostrou segura, efetiva e de baixo custo, proporcionando a completa resolução do caso; não sendo observada recidiva em acompanhamento de 28 meses.

Osteotomia le fort i: aspectos de interesse no tratamento de nasoangiofibroma juvenil / Le fort i osteotomy: interest aspects in juvenile nasoangiobibroma management

O angiofibroma nasofaríngeo é um tumor benigno, de caráter fibrovascular e de ocorrência rara. Apresenta característica localmente agressiva e destrutiva e acomete, quase que exclusivamente, homens, com predileção pela fase da adolescência. O diagnóstico é feito por meio de exame clínico e de imagens, sendo contraindicada a biópsia incisional devido ao risco elevado de sangramento de difícil controle. O tratamento é a completa excisão cirúrgica, sendo a radioterapia reservado para os casos de recidivas e tumores extensos com vascularização incomum ou extensão intracraniana. Os acessos cirúrgicos utilizados para ressecção desse tumor incluem a abordagem transmaxilar (le fort I), transantral, transpalatal, combinada, endoscópica e outras. O trabalho aborda um relato de caso, relacionando os aspectos de interessa da osteotomia Le For I, suas vantagens e desvantagens no tratamento do Angiofibroma Juvenil Nasofaríngeo.

Nasopharyngeal angiofibroma is a rare and benign tumor that has a fibrovascular feature. It has been locally aggressive and destructive that affects almost exclusively male, especially on teens.The diagnosis has done by clinical examination and radiography, but incisional biopsy is contraindicated due to risk of bleeding with difficult control. The recommended approach has been a wide surgical excision with radiotherapy being reserved for cases of recurrence and tumor vasculature with unusual or extensive intracranial extension. The surgical approaches used for resection of these tumors include the approach transmaxillary (le fort I), transnasal, transpalatal, combined endoscopic and others. The paper addresses a case report, listing the aspects of the interest of Le Fort I osteotomy, advantages and disadvantages in the treatment of Juvenile Nasopharyngeal Angiofibroma.

Odontoma Complexo Atípico: Relato de Caso / Atypical Complex Odontoma: Case Report

Os odontomas são classificados como tumores benignos, originados do epitélio e do ectomesênquima odontogênico e são considerados mais anomalias de desenvolvimento - hamartomas - do que verdadeiras neoplasias. Representam, sem dúvida, os tumores mais comumente observados entre todos aqueles de origem odontogênica. Sua etiopatogenia constitui um aspecto muito investigado, embora se apresente indeterminada, ficando restringida ao campo das hipóteses, indo desde traumatismos e infecções locais a fatores genéticos. São mais frequentemente diagnosticados na segunda década de vida. Frequentemente, encontram-se inclusos e assintomáticos e geralmente são descobertos em radiografias de rotina, sendo vistos como uma massa intensamente radiopaca, circundada por linha radiolúcida. Raramente ocorre sua irrupção em cavidade oral, e existem algumas teorias que tentam explicá-la. O presente trabalho tem por objetivo apresentar um caso clínico de extenso odontoma irrompido em cavidade oral, discutindo aspectos relevantes do ponto de vista clínico-cirúrgico.

Odontomas are classified as benign tumors arising from epithelium and mesenchyme odontogenic and are considered more developmental abnormalities - Hamartoma - than true neoplasms. Undoubtedly, they are the most commonly tumors seen among those of odontogenic origin. Its pathogenesis is a very investigated, despite presenting indeterminate, being restricted to the realm of hypotheses, ranging from local infections and trauma to genetic factors. They are most frequently diagnosed in the second decade of life, often are included and asymptomatic, and usually are discovered in routine radiographs, being seen as an intensely radiopaque mass surrounded by a radiolucent line. Rarely it occurs eruption in the oral cavity and there are some theories that might explain it. This paper aims to present a case of extensive odontoma erupted into the oral cavity, discussing relevant aspects of the clinical surgery.

Abordagem atual do trauma maxilo-facial por mordedura / Current approach to maxillofacial trauma by bite

Lesões faciais decorrentes de mordedura são freqüentemente relatadas na literatura mundial. Tais injúrias podem apresentar-se desde simples abrasões até ferimentos profundos, irregulares e com grande perda de substância, podendo comprometer severamente padrões estéticos e funcionais das vítimas. Na maioria das vezes, estas são ocasionadas por cães, gatos ou pelo próprio homem, sendo as crianças bem mais acometidas que os adultos. Locais, como couro cabeludo, face e região cervical, são freqüentemente envolvidos. Na face, os locais mais acometidos são os lábios, a região de mento, o nariz e as orelhas. O diagnóstico da presença ou não de infecção local é extremamente importante para nortear a necessidade da escolha e/ou utilização de antibioticoprofilaxia ou antibioticoterapia, não esquecendo de se avaliar quanto ao emprego de soro ou vacina anti-rábica e/ou antitetânica. Uma criteriosa avaliação física inicial associada a uma acurada anamnese são imprescindíveis. Em casos graves, muitas vezes, a necessidade de uma equipe multiprofissional se torna indispensável para o sucesso do tratamento.

Facial injuries from bites, whether by cats, dogs or humans, are commonly reported in the world literature. Such injuries range from simple abrasions to deep, irregular wounds causing a great loss of substance, seriously compromising the victims? aesthetic and functional condition. In serious cases a multidisciplinary team of professions is essential for a successful treatment.

Displasia cemento óssea florida / Florid cemento osseous dysplasia

A Displasia Cemento Óssea Florida (DCOF) é uma lesão controvertida em relação ao seu diagnostico, pelos seus aspectos clínicos e radiográficos muito semelhantes a outras lesões ósseas esclerosantes. Acomete principalmente a mandíbula de mulheres negras com idade acima de quarenta anos. Apresenta um aspecto radiográfico de massas densamente radiopacas, entremeadas por faixas radiolúcidas, sem limite definido. Pode desenvolver expansão óssea alveolar, supuração e fistulação, caso esteja associada à infecção secundaria (osteomielite), que ocorre devido à exposição da massa óssea avascular à cavidade bucal.