Profile of the demand assisted by a team of oral and maxillofacial surgeons in the city of Cuiabá, Brazi l: a time-series study / Perfil da demanda atendida por uma equipe de cirurgiões bucomaxilofacial em Cuiabá, Brasil: um estudo de série temporal

The present study aimed to characterize the procedures performed by the oral and maxillofacial surgery team at a Brazilian reference hospital in a Brazilian city, as well as to describe the time trend of the number of services related to different types of surgery. It is a time-series study that assessed the data from the medical records of patients assisted at a reference hospital in a city in the state of Mato Grosso (Brazil), from 2011 to 2017. The data were assessed using descriptive statistical analysis, correspondence analysis (CA), and time trend analysis. A total of 1488 medical records were evaluated, the majority of which corresponded to male patients (59%), extractions were the most performed procedures (46.2%), local anesthesia was the most applied technique (50.3%), and the procedures were mostly performed in an outpatient environment (53.2%). There was a decreasing global time trend (R2 = 0.248; p < 0.001). Male patients are the most assisted in hospital care and are particularly related to more invasive procedures; there is also a decreasing curve of assistance over the years in the oral and maxillofacial surgery and traumatology service of the hospital studied.

O presente estudo teve como objetivo caracterizar os procedimentos realizados pela equipe de cirurgia bucomaxilofacial em um hospital brasileiro de referência de uma cidade brasileira, bem como descrever a tendência temporal da quantidade de atendimentos relacionados a diferentes tipos de cirurgia. Trata-se de um estudo de série temporal que avaliou os dados dos prontuários de pacientes atendidos em um hospital de referência em uma cidade do estado do Mato Grosso (Brasil) entre os anos de 2011 e 2017. Os dados foram avaliados por meio de uma análise estatística descritiva, teste de Análise de correspondência (AC) e análise de tendência temporal. No total, 1488 registros foram avaliados, dos quais a maioria correspondia a pacientes do sexo masculino (59%), exodontias foram os procedimentos mais realizados (46,2%), a técnica anestésica mais empregada foi a local (50,3%) e os procedimentos foram realizados em sua maioria em âmbito ambulatorial (53,2%). A tendência temporal global foi decrescente do tempo global (R2 = 0,248; p <0,001). Os pacientes do sexo masculino são os mais assistidos no atendimento hospitalar e estão particularmente relacionados a procedimentos mais invasivos; há também uma curva decrescente de assistência ao longo dos anos no serviço de cirurgia oral e bucomaxilofacial do hospital estudado.

Atypical angiofibroma in a patient with compromised general health: A case report.

INTRODUCTION: The nasopharyngeal angiofibroma (NA) is a benign tumor that originates from the pterygopalatine fossa and extends to the adjacent anatomical structures and affects frequently young individuals. The basic treatment for NA is surgical resection, but in some cases the tumor is surgically inaccessible. CASE PRESENTATION: We describe the case of a 45-year-old male with respiratory difficulty after the appearance of a soft palate lesion. The clinical appearance of NA was not specific. DISCUSSION: There are still discussions about the best therapeutic strategy and controversies about performing incisional biopsy. To our knowledge, this is the first report of a NA in an adult patient in which the general health conditions prevented the therapeutic approach, besides the extension of the lesion and its complications. CONCLUSION: Our case shows that NA may reach high proportions and its involvement in older patients should be considered. In this report, we showed the limitation of the therapeutic strategy for advanced cases of NA.

Epidemiological Aspects of Cranioencephalic Trauma at Cuiabá Municipal Hospital, Brazil / Aspectos Epidemiológicos de los Traumatismos Craneoencefálicos Atendidos en el Hospital Municipal de Cuiabá, Brasil

ABSTRACT: Cranioencephalic trauma (CET) is defined is the combination of neural and vascular injuries and their inflammatory effects in the brain, skull and scalp. This modality of trauma may lead to motor, psychological and cognitive sequels or even death. The present study aimed to assess the main epidemiological aspects in victims of CET treated at Cuiabá Municipal Hospital (CMH), Brazil. An observational and analytical study was performed in the medical records of patients diagnosed with CET treated at CMH between July and December of 2000, 2006 and 2011. The information retrieved from the patients consisted of age, sex, place of residence, cause of trauma, association with other trauma, outcomes (death or discharge) and the severity of neurological effect (Glasgow Coma Scale). The data obtained was analyzed descriptively with absolute (n) and relative (%) quantification. Medical records of 669 victims were analyzed, out of which 567 were males (84.7 %). Male patients were aged between 20 and 39 years old (mean age: 32.8 years). The most prevalent cause of trauma was the motorcycle accident (26.6 %). The neurological severity of the CET was mild in most of the cases (32.5 %). Considering the place of residence, most of the patients (n=331; 49.5 %) were from the capital city of Mato Grosso State (Cuiabá, Brazil). Four-hundred seventy-nine (71.6 %) patients progressed without death. A high prevalence rate of CET was observed at CMH. Major attention must be given to young adult victims of motorcycle accidents.

RESUMEN: El traumatismo craneoencefálico (TCE) se define como una combinación de daño neural, insuficiencia vascular y efectos inflamatorios que comprometen el cráneo, el encéfalo y el cuero cabelludo, causando la muerte, o serias secuelas motoras, psicológicas y cognitivas. De esta forma, el objetivo de este trabajo fue evaluar los principales aspectos epidemiológicos en victimas de Traumatismo Craneoencefálico (TCE) atendidas en el Hospital y Sala de Primeros Auxilios Municipal de Cuiabá (HPSMC), Brasil. Se trata de un estudio observacional de historias clínicas del archivo del HPSMC, admitidos con diagnóstico de TCE en el período de julio a diciembre de los años 2000, 2006 y 2011. Se consideraron el rango de edad, el sexo, la procedencia de las víctimas, la causa del trauma, la asociación con otros traumas, la defunción y el alta, el cuadro neurológico (Escala de Coma de Glasgow - ECG). El análisis de los datos fue descriptivo con números absolutos y porcentajes. Se evaluaron historias clínicas de 669 víctimas de TCE, en los que el sexo masculino fue el de mayor prevalencia con 567 casos (84,7 %), con mayor incidencia en el rango de edad de 20 a 39 años (39,2 %), el promedio de edad fue de 32,8 años, siendo la etiología más frecuente los accidentes motociclísticos (26,6 %). En el momento de la admisión de acuerdo al ECG hubo una predominancia de TCE leve (32,5 %). En cuanto a la procedencia, 331 (49,5 %) eran del municipio de Cuiabá. Del total de víctimas, 479 (71,6 %) evolucionaron hasta tener el alta hospitalaria. Se registró una prevalencia elevada de TCE en el HPSMC, con predominancia de víctimas adultas jóvenes de sexo masculino, siendo los accidentes motociclísticos la principal causa.

Removal of Multiple Keratocystic Odontogenic Tumors in a Nonsyndromic Patient.

Multiple keratocystic odontogenic tumors are one of the key features of Gorlin-Goltz syndrome. A 15-year-old nonsyndromic female child presented with multiple keratocystic odontogenic tumors. The presence of the tumors was observed in immunological examinations. The images led to the suspicion of Gorlin-Goltz syndrome which was discarded after analyzing the patient's medical history and complementary examinations. Le Fort I osteotomy was opted to access the maxillary tumors favoring visibility and allowing simultaneous bilateral accesses. A sagittal vestibular incision in the lower rim was performed to access the mandibular lesions. After 3 months, the patient underwent a bilateral myotomy to reduce the volume of the masseter muscles. The occurrence of nonsyndromic multiple keratocystic odontogenic tumors is rare. Clinicians facing this situation shall seek for other known features of the Gorlin-Goltz syndrome and follow up closely these patients for the possibility of occurrence of basal cell carcinoma.

Reduced chromatin acetylation of malignant salivary gland tumors correlates with enhanced proliferation.

BACKGROUND: Epigenetic changes refer to any heritable modification in gene expression independent of alterations in the DNA sequence. Currently, it is well established that epigenetics represents a crucial player for tumor development. Nevertheless, the epigenetic mechanisms involved in the development and progression of salivary gland tumors (SGTs) remain poorly understood. METHODS: In this study, we analyzed the pattern of acetyl-histone H3 (lys9) expression in benign and malignant SGTs and further correlate our results with tumors' proliferative activity and clinical outcomes. We assembled tissue microarrays (TMAs) of 84 cases of SGTs and analyzed for acetyl-histone H3 (lys9) and Ki-67 using immunohistochemistry. The study comprised 42 benign and 42 malignant SGTs. RESULTS: All cases included in this study were positive to acetyl-H3 (lys9). We observed that malignant SGTs were hypoacetylated compared with benign (P = 0.04). Moreover, acetyl-H3 (lys9) expression was inversely correlated with Ki67 (**P = 0.02). CONCLUSION: This study provides the first insight regarding histone modifications in SGTs. Our results suggest that epigenetic mechanism, particularly hypoacetylation of histone H3 (lys9), might play a role in the behavior of salivary gland tumors. Also, our findings suggest that interfering with the acetylation pattern of tumor histones represents a potential novel therapeutic strategy for the treatment of SGTs.

Lipoma of the Palate: An Uncommon Finding.

BACKGROUND: Lipoma is a benign neoplasm originated from adipose cells circumscribed by connective tissue. This neoplasm represents about 1% to 4.4% of all oral benign tumors and it is rarely located in the palate area. OBJECTIVE: This case reports the occurrence of an oral lipoma in the hard palate of a 57-year-old woman and discusses its etiology and treatment. CASE REPORT: The treatment consisted in the total resection of the lesion and laser therapy. The patient is being followed up for forty three months with no signs of recurrence. CONCLUSION: Lipoma in hard palate is a rare entity that may be associated with endocrine factors and local inflammation.

Clinicopathological analysis of salivary gland tumors over a 15-year period.

Salivary gland tumors (SGT) are rare neoplasms that generate interest due to their histopathological diversity and clinical behavior. The aims of the present study were to investigate clinicopathological aspects of SGTs diagnosed at a tertiary health center and compare the findings with epidemiological data from different geographic locations. Cases of tumor in the head and neck region at a single health center in the period between 1995 and 2010 were reviewed. Patient gender, age and ethnic group as well as anatomic location, histological type and clinical behavior of the tumor were recorded. Availability of complete information about these aspects was considered the inclusion criteria. Descriptive statistical analysis of the data was performed using the frequencies of categorical variables. Among the 2168 cases of tumors in the head and neck region, 243 (11.20%) cases were diagnosed in the salivary glands, 109 of which met the inclusion criteria: 85 (78%) benign tumors and 24 (22%) malignant tumors. Mean patient age was 46.47 years. The female gender accounted for 56 cases (51.4%) and the male gender accounted for 53 (48.3%). The major salivary glands were affected more (75.2%) than the minor glands. The most frequent benign and malignant SGTs were pleomorphic adenoma (81.2%) and adenoid cystic carcinoma (58.3%), respectively. In conclusion, pleomorphic adenoma and adenoid cystic carcinoma are the most frequent benign and malignant lesions, respectively. Comparing the present data with previous studies on SGTs, one may infer that some demographic characteristics and the predominance of malignant tumors vary in different geographic regions.

Clinicopathological analysis of salivary gland tumors over a 15-year period

Abstract Salivary gland tumors (SGT) are rare neoplasms that generate interest due to their histopathological diversity and clinical behavior. The aims of the present study were to investigate clinicopathological aspects of SGTs diagnosed at a tertiary health center and compare the findings with epidemiological data from different geographic locations. Cases of tumor in the head and neck region at a single health center in the period between 1995 and 2010 were reviewed. Patient gender, age and ethnic group as well as anatomic location, histological type and clinical behavior of the tumor were recorded. Availability of complete information about these aspects was considered the inclusion criteria. Descriptive statistical analysis of the data was performed using the frequencies of categorical variables. Among the 2168 cases of tumors in the head and neck region, 243 (11.20%) cases were diagnosed in the salivary glands, 109 of which met the inclusion criteria: 85 (78%) benign tumors and 24 (22%) malignant tumors. Mean patient age was 46.47 years. The female gender accounted for 56 cases (51.4%) and the male gender accounted for 53 (48.3%). The major salivary glands were affected more (75.2%) than the minor glands. The most frequent benign and malignant SGTs were pleomorphic adenoma (81.2%) and adenoid cystic carcinoma (58.3%), respectively. In conclusion, pleomorphic adenoma and adenoid cystic carcinoma are the most frequent benign and malignant lesions, respectively. Comparing the present data with previous studies on SGTs, one may infer that some demographic characteristics and the predominance of malignant tumors vary in different geographic regions.

The influence of fränkel-2 function regulator in the lower anterior teeth crown length / Influência da utilização do regulador de função frankel-2 no comprimento da coroa clínica dos dentes anteriores inferiores

Functional orthopedic appliances used for Class II malocclusion treatment, usually work by guiding jaws growth and modifying dental positions. Among these dentoalveolar effects, it is the lower incisors buccal tipping, that helps to improve the overjet, but may cause gingival recessions, especially when associated with other etiological factors. The objective of this study was to evaluate the clinical crown length of the lower anterior teeth in individuals with Angle's Class II malocclusion, after treatment with Fränkel-2 function regulator appliance (RF-2). Fifty Class II-malocclusion individuals were divided into 2 groups: G1 ­ 14 male, and 11 female, treated with the Fränkel-2 function regulator appliance for 18 months, with average pre-treatment age (T1) of 11 years (sd=7 months) and average post-treatment age (T2) of 12 years and 7 months (sd=7 months); and G2 ­ a control group with 25 individuals (12 male and 13 female) with average age at T1 of 10 years and 3 months (sd=11 months) and at T2 of 12 years and 1 month (sd=11 months), which was part of a normal occlusion sample. The 100 dental cast models were analyzed at T1 and T2, with a digital caliper, measuring the distance from the incisal edge to the most concave portion of the gingival margin of lower incisors and canines. Data were checked by a Student's t-test and a paired t-test. Considering T2, the group 1 presented a significant increase in the crown length of all lower anterior teeth. On the other hand, in the group 2, this was observed only for the teeth 33, 42 and 43, suggesting that patients treated with RF-2 had more gingival recession than the control group.

Os aparelhos ortopédicos funcionais utilizados para o tratamento da má oclusão de Classe II normalmente atuam guiando o crescimento dos maxilares e modificando as posições dentais. Dentre esses efeitos dento alveolares está a inclinação dos incisivos inferiores para vestibular, o que auxilia na melhora do overjet, mas pode causar recessões gengivais, especialmente se associado a outros fatores etiológicos. O objetivo deste estudo foi avaliar o comprimento da coroa clínica dos dentes anteriores inferiores em indivíduos com má oclusão de Classe II, após o tratamento com o aparelho regulador de função Fränkel-2 (RF-2). Cinquenta indivíduos com Classe II foram divididos em dois grupos: G1 ­ 14 meninos e 11 meninas, tratados com o aparelho regulador de função Frankel-2, por 18 meses, com média de idade pré-tratamento (T1) de 11 anos (DP=7 meses) e média de idade pós-tratamento (T2) de 12 anos e 7 meses (DP=7 meses); e G2 ­ um grupo controle com 25 indivíduos (12 meninos e 13 meninas) com média de idade em T1 de 10 anos e 3 meses (DP=11 meses) e em T2 de 12 anos e 1 mês (DP=11 meses), que fazia parte de uma amostra de oclusão normal. Os 100 modelos de gesso foram avaliados em T1 e T2, com um paquímetro digital, medindo a distância da borda incisal à parte mais côncava da margem gengival dos incisivos e caninos inferiores. Os dados foram checados pelo teste t de Student e pelo teste t pareado. Considerando T2, o grupo 1 apresentou um aumento significante no comprimento das coroas de todos os dentes anteriores inferiores. Por outro lado, no grupo 2, isto foi observado somente para os dentes 33, 42 e 43, sugerindo que os pacientes tratados com o RF-2 apresentaram mais recessões gengivais do que o grupo controle.

Immunoprofile of c-MET/PI3K signaling in human salivary gland tumors.

OBJECTIVE: The aim of this study was to analyze the expression pattern of proteins in the HGF/c-MET/PI3K signaling pathway in salivary gland tumors (SGTs) and to correlate the findings with the proliferative index and clinical parameters. STUDY DESIGN: We assembled tissue microarrays (TMAs) of 108 cases of SGTs, including 69 cases of pleomorphic adenoma (PA), 24 cases of adenoid cystic carcinoma (AdCC), and 15 cases of mucoepidermoid carcinoma (MEC). An immunohistochemical analysis of hepatocyte growth factor (HGF), MET phosphorylation (p-MET), protein kinase B (AKT) phosphorylation (p-AKT), and Ki-67 proteins was performed. RESULTS: Benign and malignant SGTs presented similar scores of HGF-positive cells (P = .36), whereas, malignant SGTs exhibited higher levels of p-MET (P = .001) and p-AKT (P = .001) than benign SGTs. No correlation of HGF, p-MET, or p-AKT expression was observed with clinical parameters. PA had a lower proliferative index than either AdCC (P = .001) or MEC (P = .001). CONCLUSIONS: The salivary gland carcinomas exhibited increased activation of the HGF pathway, as evidenced by the phosphorylation of the MET receptor, and increased activation of the PI3K pathway, as indicated by p-AKT. These data suggest that the HGF/c-MET/PI3K signaling pathway is active in SGTs, especially in malignant neoplasms.

Ki-67, TGF-ß1, and elastin content are significantly altered in lip carcinogenesis.

Epithelial changes observed in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC) have been studied using different markers in order to observe diagnostic and prognostic factors for both lesions. The aim of the present study was to analyze Ki-67, TGF-ß1, and elastin content in AC and LLSCC to determine the possible role of these proteins in lip carcinogenesis. Medical records of 29 cases of AC and 53 cases of LLSCC were analyzed. Lesions were classified according histological pattern and submitted to immunostaining for Ki-67, TGF-ß1, and elastin. Different percentages of Ki-67-positive cells were found in AC depending on the degree of epithelial dysplasia (p < 0.01). An association was also found between the percentage of Ki-67-positive cells and tumor grade in LLSCC (p < 0.01). An inverse correlation was found between Ki-67 and TGF-ß1 in AC and LLSCC (p < 0.01). Elastosis was thinner and more discontinuous in LLSCC in comparison to AC, and this difference in the elastin immunolabeling pattern was statistically significant between groups (p < 0.01). The present findings indicate that changes in Ki-67 and TGF-ß1 content contribute to lip carcinogenesis. Furthermore, elastin content reflects changes in the extracellular matrix in both AC and LLSCC.

Prevalência de onicofagia na clínica ortodôntica / Prevalence of nail biting in orthodontic clinic

A literatura tem evidenciado que a onicofagia é o hábito mais prevalente na infância, podendo provocar, em longo prazo, alterações estruturais e funcionais no sistema estomatognático. Por esse motivo, conhecer a sua prevalência em clínicas/escolas pode ser importante para a implantação de programas educativos e preventivos interdisciplinares. Objetivo: avaliar a prevalência de onicofagia na clínica ortodôntica da Universidade Metodista de São Paulo. Método: por meio de estudo restrospectivo, foram analisadas 1.118 documentações ortodônticas do programa de pós-graduação em Ortodontia da Umesp, verificando-se as variáveis sexo, idade, raça e presença ou ausência de onicofagia. Os resultados foram submetidos a tratamento estatístico (teste qui-quadrado, com nível de significância de 5%). Resultados: a amostra foi composta prioritariamente por indivíduos entre 11 e 20 anos ? 82,9%, sendo 596 (53,3%) mulheres e 522 (46,7%) homens, destes, 27,8% são onicofágicos. Não houve diferença estatisticamente significante entre as variáveis onicofagia, sexo e idade, muito embora tenha havido diferença entre o hábito deletério oral da onicofagia e a variável raça (leucodermas e xantodermas). Conclusão: o hábito oral deletério de onicofagia ocorreu em 27,8% da amostra e não apresentou, no grupo de estudo, preferência quanto a idade, sexo e raça, com exceção de leucodermas quando comparados a xantodermas.