Nasopalatine Duct Cyst in a 31 Year-Old Male: Imaging Findings in Computed Tomography / Quiste del Canal Nasopalatino en un Hombre de 31 años: Hallazgos en Imágenes de Tomografía Computarizada

A 31-year-old man is presented and is evaluated by panoramic radiography. As a finding, an extensive lesion with a cystic appearance was detected in the anterior part of the maxilla. Computed tomography shows a lesion corresponding to the characteristics of a cyst. In the histology the combination of two types of epithelium is observed, pseudostratified columnar and stratified squamous, confirming that this was a nasopalatine duct cyst.

Se presenta el caso de un hombre de 31 años, evaluado mediante radiografía panorámica. Como hallazgo se detecta una extensa lesión de aspecto quístico en la parte anterior del maxilar. En la tomografía computada se observa una lesión que corresponde a las carácterísticas de un quiste. La histología muestra una combinación de dos tipos de epitelio, pseudostratificado columnar y estratificado escamoso, confirmando que se trataba de un quiste del canal nasopalatino.

Volumetric changes in the size of odontogenic keratocysts after decompression followed by enucleation, peripheral ostectomy, and Carnoy's solution: A retrospective study.

The study aimed to retrospectively analyze the reduction pattern of odontogenic keratocysts (OKCs) after decompression, followed by enucleation (EN), peripheral ostectomy (PO), and Carnoy's solution (CS) to establish the appropriate time for inserting implants, along with assessing the long-term success of conservative treatment with adjunctive therapy. The predictable variables were the reduction pattern and the study's treatment option. The outcome variable was the volumetric changes in the size of bony defects. These changes were determined using a percentage difference and a reduction rate. They were recorded after decompression and one, three, six, twelve, and eighteen months after EN. P-values of .05 were considered significant. The study included 66 patients with 71 OKCs. Males, younger ages, and mandibular OKCs significantly predominated. The decompression significantly changed the initial volume from 135.40 ± 1.2 cm3 to 101.55 ± 0.1 cm3 with 28.6 percentage difference and 25% reduction rate. At the end of the first and third months after EN, the reduction pattern is 50.0%-75.5% of the initial volume, with no significant prediction for the direction of the reduction pattern. After 18 months, all bony defects disappeared, with no recurrences for the next 18 years. In conclusion, the reduction pattern is 75.5% of its initial volume at the end of the third month after OKC management. Therefore, within the limitations of the study, its treatment approach seems to be an option amongst other protocols that includes a view to early implant based dental rehabilitation.

[Innovative methods and developments in oral care. 3D planning in oral and maxillofacial surgery]. / Serie: Innovatieve technieken en ontwikkelingen in de mondzorg. 3D-planning in de mka-chirurgie.

With the use of cone beam computed tomography, intraoral scanning and 3D stereophotogrammetry, a virtual 3D head model of a patient can be reconstructed with image fusion. In this way, the malposition, deficiency and other anomalies at the level of bone, dentition and soft tissue can be quantified objectively. The desired position of the dentition, occlusion and soft tissue in the facial profile can be virtually drawn in and used as a guideline for treatment planning. Based on the principle of backward planning, it is possible to determine what repositioning of the jaw is required, where there is a need for bone augmentation and how many dental implants are necessary to obtain the desired treatment outcome. From this perspective, 3D treatment planning has become a treatment standard for the 4 clinical pillars supporting oral and maxillofacial surgery, specifically orthognathic surgery, implantology, craniofacial surgery and head & neck oncology. 3D planning has influenced today's workflow, planning of complex surgery and contributed to useful further innovations and efficient healthcare.

Prevalence and extent of Alveolar dehiscence and fenestration in Class I hyperdivergent subjects with different buccolingual inclinations of maxillary molar teeth: a CBCT study

Buccolingual position of teeth could affect the prevalence of alveolar bone defects. Presence of alveolar defects may have a deleterious effect on orthodontic treatment. The aim was to assess the prevalence and extent of dehiscence and fenestration in Class I hyperdivergent subjects and correlate it with buccolingual inclinations(BL) of maxillary first molar teeth. Methods: This retrospective study involved 80 CBCTs of class I hyperdivergent subjects divided into two groups - group A (n=33) buccolingual inclination >9º and group B (n=47) buccolingual inclination <9º. Prevalence and extent of alveolar bone dehiscence and fenestrations were measured in CBCTs using OSIRIX Lite software. Descriptive statistics, Mann Whitney U test and Spearman correlation were done for evaluating intergroup differences and correlation with Buccolingual inclination. Results: Overall prevalence of dehiscence and fenestration in maxillary first molars was 60.95% and 5% respectively. In the buccal alveolar bone, prevalence of dehiscence was highest in group A (84.6%) for 16 and in the lingual alveolar bone prevalence of dehiscence was highest in group B (71.4%) for 26 . On intergroup comparison, the extent of lingual alveolar bone dehiscence (26) in group B was significantly higher (p value <0.05) than in group A. No significant correlation between the extent of dehiscence and fenestration with buccolingual inclination of molar teeth was noted. Conclusion: Molar teeth with BL inclinations of more than 9º had higher prevalence of dehiscence on the buccal side and molar teeth with BL inclinations less than 9 degrees had more dehiscence on the lingual side. But no significant correlation of BL inclination with prevalence and extent of dehiscence and fenestration was noted

Tratamento cirúrgico da osteomielite dos maxilares: relato de caso / Surgical treatment of osteomyelitis of the jaws: Case report / Tratamento quirúrgico de la osteomielitis de los maxilares: reporte de um caso

A Osteomielite dos Maxilares (OM) é uma inflamação óssea, de origem na maioria infecciosa, podendo atingir a porção medular e cortical dos ossos maxilares. Apresenta-se em maior extensão na mandíbula, devido ao pobre suprimento sanguíneo que essa possui, sendo mais prevalente em homens entre a faixa etária de 40 a 60 anos. Sua etiologia está relacionada principalmente às infecções odontogênicas, infecções secundárias e corpos estranhos ocasionais, como os implantes dentários. Tem-se por objetivo apresentar um relato de caso clínico sobre OM na região posterior da mandíbula, bem como sua associação a uma insatisfatória implantação dentária onde houve desenvolvimento de lesão peri-implantar. Paciente do gênero feminino, 53 anos, melanoderma, apresentou dor crônica, abaulamento ósseo sem outros sinais significativos na região de molares inferiores no lado direito, radiograficamente visualizava-se imagem mista sendo sugestiva de sequestro ósseo. Na história pregressa relatou ter realizado explantação na referida região após ser diagnosticada com peri implantite. Ao final do estudo concluiu-se que a afecção teve como causa a infecção bacteriana proveniente de contaminação durante a inserção de implante dentário. Optou-se por remoção cirúrgica do osso necrótico e inflamado... (AU)

Osteomyelitis of the Jaws (OM) is a bone inflammation, of mostly infectious origin, which can affect the medullary and cortical portion of the maxillary bones. It presents itself to a greater extent in the mandible, due to the poor blood supply that it has, being more prevalent in men between the age group of 40 to 60 years. Its etiology is mainly related to odontogenic infections, secondary infections and occasional foreign bodies, such as dental implants. The objective is to present a clinical case report on OM in the posterior region of the mandible, as well as its association with an unsatisfactory dental implantation, where there was development of a peri-implant lesion. Female patient, 53 years old, melanoderma, presented chronic pain, bone bulging without other significant signs in the region of lower molars on the right side, radiographically a mixed image was visualized, suggesting bone sequestration. In her previous history, she reported having performed explantation in that region after being diagnosed with peri-implantitis. At the end of the study, it was concluded that the disease was caused by bacterial infection from contamination during dental implant insertion. We opted for surgical removal of the necrotic and inflamed bone... (AU)

La osteomielitis de los maxilares (OM) es una inflamación de los huesos, en su mayoría de origen infeccioso, que puede afectar la porción medular y cortical de los huesos maxilares. Se presenta en mayor medida en la mandíbula, debido a la escasa irrigación sanguínea que tiene, siendo más prevalente en hombres entre el grupo de edad de 40 a 60 años. Su etiología se relaciona principalmente con infecciones odontogénicas, infecciones secundarias y cuerpos extraños ocasionales, como los implantes dentales. El objetivo es presentar un reporte de caso de OM en la región posterior de la mandíbula, así como su asociación con una implantación dentaria insatisfactoria a partir de la cual desarrollamos una lesión periimplantaria. Paciente femenina, 53 años, melanodermia, presenta dolor crónico, tumefacción ósea con otros signos significativos en región molar inferior del lado derecho, radiográficamente se visualiza imagen mixta sugestiva de pérdida ósea. En su historia previa menciona haber realizado una explantación en esa región tras ser diagnosticada de periimplantitis. Al final del estudio, se concluyó que la enfermedad fue causada por una infección bacteriana provocada por la contaminación durante la inserción del implante dental. Se optó por la extirpación quirúrgica de la piel necrótica e inflamada... (AU)

Rosai Dorfman's disease of the maxillary bone with soft tissue involvement of the cheek: Case Presentation and Literature Review / Enfermedad de Rosai Dorfman de maxilar con compromiso de partes blandas de mejilla: Presentación de caso y revisión de la literatura

The Rosai-Dorfman disease (RDD) is a bening entity, of unknown etiology, rare, characterized by the overproduction of histiocytes and their subsequent accumulation in the lymph nodes, which may also compromise other organs and systems. It predominantly affects young people. The histological study, which shows emperipolesis, is very indicative but not pathognomonic, but with the immunohistochemistry the diagnosis of the disease is reached, which does not have a well-protocolized treatment. Its evolution is highly variable, with spontaneous remission being a possibility, although in some cases the commitment is extensive, compromising important or vital anatomical structures that requiere vigorous treatment, which can be surgical, radiotherapy and even chemotherapy. We present a case of RDD that affected a 17-year-old girl with upper jaw and right maxillary sinus commitment, which began with loss of teeth, and subsequent appearance of a painless and deforming facial tumour that underwent surgical resection. In this case, the etiological diagnosis was not posible in the preoperative period despite multiple biopsies. An extensive review of the literature is carried out in order to a better understanding of this pathology.

La Enfermedad de Rosai-Dorfman (ERD) es una entidad benigna, de etiología desconocida, poco frecuente, caracterizada por la sobreproducción de histiocitos y su posterior acúmulo en los linfonodos, pudiendo comprometer también a otros órganos y sistemas. Afecta predominantemente a personas jóvenes. El estudio histológico, que muestra emperipolesis, es muy orientativa pero no patognomónica, aunque con la Inmunohistoquímica se llega al diagnóstico de la enfermedad que no tiene un tratamiento bien protocolizado. Su evolución es muy variable, siendo la remisión espontánea una posibilidad, no obstante, en algunos casos, el compromiso es extenso, comprometiendo estructuras anatómicas importantes o vitales que requieren de un tratamiento enérgico, pudiendo ser éste quirúrgico, radioterápico y aún quimioterápico. Se presenta un caso de ERD que afectó a una joven de 17 años, con compromiso de maxilar y seno maxilar derecho, que debutó con pérdida de piezas dentarias y posterior aparición de un tumor facial indoloro y deformante que fue sometido a resección quirúrgica. En este caso no fue posible el diagnóstico etiológico en el preoperatorio pese a múltiples biopsias. Se hace una extensa revisión de la literatura con el objeto de conocer mejor esta patología.

Queratoquistes odontogénicos maxilares en paciente con síndrome de Gorlin. Descripción de un caso y revisión de la literatura / Maxillary odontogenic keratocysts in a Gorlin síndrome patient: Case report and literatura review

Los queratoquistes maxilares son frecuentes en pacientes con síndrome de Gorlin. Su tratamiento es debatido por su alta tendencia a la recidiva. En los últimos años la cirugía endoscópica nasosinusal ha adquirido importancia en el manejo de esta patología. Exponemos en caso de un varón de 16 años afecto de este síndrome con queratoquistes maxilares donde se realiza un abordaje combinado, endonasal y transoral.

Maxillary keratocysts are frequent in Gorlin Syndrome patients. Its treatment is discussed due to the high tendency to recurrence. In the last years the sinonasal endoscopic surgery has become an important tool in the management of this pathology. We report a 16 years old boy with Gorlin Syndrome and maxillary keratocysts treated with a trans-nasal endoscopic and intra-oral combined approach.

[Imaging features of multiple maxillomandibular brown tumors: a case report]. / Imagerie des tumeurs brunes maxillo-mandibulaires multiples: à propos d'un cas.

Brown tumors are rare osteolytic lesions occurring in 1.5-1.7% of patients with chronic end-stage renal failure. They are caused by PTH-induced bone remodeling. We here report the case of a young woman on hemodialysis for chronic end-stage renal failure with painless maxillo-mandibular swellings occurred 7 months before. Clinical examination showed facial deformity with two maxillary and mandibular masses to palpation. Laboratory tests revealed hypocalcemia, hyperphosphatemia with hyperparathyroidism. CT scan of the face revealed multiple osteolytic masses in the maxillary and mandibular bones, with significant bone rarefaction and signs of diffuse bone resorption. The diagnosis of multiple brown tumors of the face was retained based on clinical, biological and radiological features. Brown tumors are a rare entity usually characterized by maxillomandibular involvement in patients with chronic renal failure. Practitioners should suspect them, hence the interest in this study.

Glucagon-Like Peptide-1 Receptor Agonist Liraglutide Ameliorates the Development of Periodontitis.

Periodontitis is one of the diabetic complications due to its high morbidity and severity in patients with diabetes. The prevention of periodontitis is especially important in diabetic patients because the relationship between diabetes and periodontitis is bidirectional. Here, we evaluated the impacts of glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide on the amelioration of periodontitis. Five-wk-old Male Sprague-Dawley (SD) rats (n = 30) were divided into 3 groups: normal, periodontitis, and periodontitis with liraglutide treatment groups. Periodontitis was induced by ligature around the maxillary second molar in SD rats. Half of the rats were administered liraglutide for 2 weeks. Periodontitis was evaluated by histological staining, gene expressions of inflammatory cytokines in gingiva, and microcomputed tomography. Periodontitis increased inflammatory cell infiltration, macrophage accumulation, and gene expressions of tumor necrosis factor-α and inducible nitric oxide synthase in the gingiva, all of which were ameliorated by liraglutide. Liraglutide decreased M1 macrophages but did not affect M2 macrophages in periodontitis. Moreover, ligature-induced alveolar bone resorption was ameliorated by liraglutide. Liraglutide treatment also reduced osteoclasts on the alveolar bone surface. These results highlight the beyond glucose-lowering effects of liraglutide on the treatment of periodontitis.

A new anabolic compound, LLP2A-Ale, reserves periodontal bone loss in mice through augmentation of bone formation.

BACKGROUND: Currently, there are no effective medications to reverse periodontal disease (PD)-induced bone loss. The objective of this study was to test a new anabolic compound, LLP2A-Ale, or with the combination treatment of mesenchymal stromal cell (MSC), in the treatment of bone loss secondary to PD. METHODS: PD was induced in mice by placing a ligature around the second right molar. At one week after disease induction, the mice were treated with placebo, LLP2A-Ale, MSCs, or combination of LLP2A-Ale + MSCs, and euthanized at week 4. RESULTS: We found that PD induced alveolar bone loss that was associated with reduced bone formation. LLP2A-Ale alone or in combination with MSCs sustained alveolar bone formation and reversed alveolar bone loss. Additionally, PD alone caused systemic inflammation and increased the circulating levels of G-CSF, IP-10, MIP-1a, and MIP2, which were suppressed by LLP2A-Ale +/- MSCs. LLP2A-Ale +/- MSCs increased bone formation at the peripheral skeletal site (distal femur), which was otherwise suppressed by PD. CONCLUSION: Our findings indicated that LLP2A-Ale treatment rescued alveolar bone loss caused by PD, primarily by increasing bone formation. LLP2A-Ale also attenuated the circulating levels of a series of inflammatory cytokines and reversed the PD-induced suppression of systemic bone formation.

Retrospective 3D analysis of bone regeneration after cystectomy of odontogenic cysts.

BACKGROUND/OBJECTIVE: In this retrospective study, we aimed to investigate a new 3D evaluation method for evaluating bone regeneration after cystectomy of odontogenic cysts. METHODS: The study included 26 patients who underwent cystectomies between 2012 and 2017 and had received either fillings or non-fillings with autologous iliac crest. Bony regeneration was analyzed using 3D imaging software and comparing identical regions of interest (ROIs) that were determined by exact overlays of the postoperative cone beam computer tomography (CBCT) or computer tomography (CT) images. Outcome measures, including volume changes according to the defect size and configuration, patient age, the entity and distribution of the cysts, were collected. RESULTS: Twenty-six patients (5 women and 21 men) had 30 defects, including nine keratocysts, seven radicular cysts and 14 dentigerous cysts. A total of 73% of the defects were in the mandible. The mean 3D follow-up time was 12 months. According to the 3D evaluation of bony regeneration, the defect size and configuration showed no significant differences between the groups (filled or non-filled with 15 defects per group). CONCLUSIONS: By establishing a standardized 3D method for evaluating bone regeneration, healing can be better monitored and evaluated.

Removal of odontogenic keratocyst in maxilla through the Le Fort i osteotomy / Eliminación de queratoquiste odontogénico en el maxilar mediante la osteotomía Le Fort

The odontogenic keratocyst is a lesion with specific clinical and histopathological aspects. The World Health Organization (WHO) in 2017 reclassified it from a tumor to a cyst. It is characterized as a cyst of epithelial development of the jaws, arising from the remains of the dental blade. It represents 3 % to 11 % of all odontogenic cysts and 7 to 11 % of cysts of the gnatic bones. It stands out for its aggressive nature and high relapsing potential. Most of the cases are diagnosed in individuals between 10 and 40 years old, with a mild preference for the masculine gender, occurring more in the mandible. Radiographically, it is radiolucent and well delimited, predominantly unilocular, and may cause displacement of adjacent teeth. The present study aims to report a clinical case of a female 25 years old patient, presenting an intra-osseous lesion in the maxilla (posterior, left side), asymptomatic, with a slight increase in intraoral buccal volume, containing the tooth 28, with a diagnostic hypothesis of Odontogenic Keratocyst. The patient was submitted to the surgical decompression treatment, with cystic fluid puncture, biopsy of the lesion and posterior anatomopathological examination. The enucleation of the tumor was performed using LeFort I osteotomy of maxilla and reconstruction with titanium mesh. There is radiographic evidence of bone repair and lesion reduction. The patient is in periodic follow-up of 4 years and does not present clinical and radiographic signs of relapse. Due to the aggressiveness of the odontogenic keratocyst, the relapse rate is high. The knowledge of the techniques recommended for the treatment of Odontogenic Keratocysts and the clinical and radiographic follow-up of the patient demonstrate a gradual decrease of the lumen of the lesion and suggest local bone neoformation, favoring the prognosis of the case.

El queratoquiste odontogénico es una lesión con aspectos clínicos e histopatológicos específicos. La Organización Mundial de la Salud (OMS) en 2017 lo reclasificó de un tumor a un quiste. Se caracteriza como un quiste de desarrollo epitelial de las mandíbulas, que surge de los restos de la lámina dental. Representa del 3 % al 11 % de todos los quistes odontogénicos y del 7 al 11 % de los quistes de los huesos gnáticos. Se destaca por su naturaleza agresiva y su alto potencial de recaídas. La mayoría de los casos se diagnostican en individuos de entre 10 y 40 años, con una leve preferencia por el sexo masculino, que ocurre más en la mandíbula. Radiográficamente, es radiotransparente y bien delimitado, predominantemente unilocular, y puede causar el desplazamiento de los dientes adyacentes. El presente estudio tiene como objetivo reportar el caso clínico de una paciente de 25 años, que presenta una lesión intraósea en el maxilar (posterior, lado izquierdo), asintomática, con un ligero aumento en el volumen bucal intraoral, que contiene el diente 28, con una hipótesis diagnóstica de queratoquiste odontogénico. El paciente fue sometido al tratamiento quirúrgico de descompresión, con punción de líquido quístico, biopsia de la lesión y examen anatomopatológico posterior. La enucleación del tumor se realizó con osteotomía LeFort I de maxilar y reconstrucción con malla de titanio. Existe evidencia radiográfica de reparación ósea y reducción de la lesión. El paciente se encuentra en seguimiento periódico de 4 años y no presenta signos clínicos ni radiográficos de recaída. Debido a la agresividad del queratoquiste odontogénico, la tasa de recaída es alta. El conocimiento de las técnicas recomendadas para el tratamiento de los queratoquistes odontogénicos, y el seguimiento clínico y radiográfico del paciente, demuestran una disminución gradual del lumen de la lesión y sugieren neoformación ósea local, favoreciendo el pronóstico del caso.

The Accuracy of Maxillary Position Using a Computer-Aided Design/Computer-Aided Manufacturing Intermediate Splint Derived Via Surgical Simulation in Bimaxillary Orthognathic Surgery.

PURPOSE: The purpose of this study was to assess the clinical interventions and the accuracy of maxillary reposition using a computer-aided design/computer-aided manufacturing (CAD/CAM) splint derived via surgical simulation. MATERIALS AND METHODS: The retrospective study comprised 24 patients who underwent bimaxillary surgery. The patients were assigned to 1 of 2 groups by a way of maxillary repositioning. One group received conventional intermediate wafers and the other CAD/CAM wafers during Le Fort I osteotomy. We recorded operation time, blood loss, the operative accuracy. Accuracy was analyzed by 3-dimensional computed tomography images before and immediately after the operation. The evaluation points were the right maxillary first incisor (U1), the right maxillary second molar (M2-right), and the left maxillary second molar (M2-left). RESULTS: The 2 groups did not differ significantly in operation time and blood losses. The vertical axis of U1 data differed significantly between the 2 groups (P = 0.008). None of the horizontal, vertical, or anteroposterior axis of M2-right data differed significantly, and anteroposterior axis of M2-left data differed significantly (P = 0.0296). The CAD/CAM group 3-dimensional distance errors were less than those of the conventional group for all points. CONCLUSION: Placement of CAD/CAM splint allowed highly accurate repositioning; the accuracy exceeded that afforded by conventional model surgery using a facebow and articulator.

Enucleation of Odontogenic Cyst with Bone Graft / Enucleación de Quiste Odontogénico con Injerto Óseo

ABSTRACT: Periapical cyst originates from an inflammatory reaction in the body that occurs due to a long-term endodontic aggression. It is more prevalent in caucasian male, during the third decade of life, in the anterior portion of the maxilla. They are commonly radiographic findings, due to their asymptomatic aspect. This study reports a Periapical Cyst in the portion corresponding to teeth 21, 22 and 23, which was treated by enucleation of the cyst, apicoectomy and retrograde root filling with Mineral trioxide aggregate (M.T.A) of teeth 21 and 22, filling of the cyst cavity with xenogeneic bone graft GenOx and a collagen membrane Gen-Derm. Observations after three months show good and rapid bone regeneration, periodontal and periapical health of the teeth involved.

RESUMEN: El quiste periapical se origina de una reacción inflamatoria que ocurre debido a una agresión endodóntica a largo plazo. Es más frecuente en el varón caucásico, durante la tercera década de la vida, en la porción anterior del maxilar. Son comúnmente hallazgos radiográficos, debido a su aspecto asintomático. En este estudio informamos acerca de un quiste periapical, en la porción correspondiente a los dientes 21, 22 y 23, que se trató mediante enucleación, apicectomía y relleno de raíz retrógrada con agregado de trióxido mineral (MTA) de los dientes 21 y 22, relleno de la cavidad del quiste con injerto óseo xenogénico Gen-Ox y una membrana de colágeno GenDerm. Las observaciones después de tres meses mostraron una buena y rápida regeneración ósea, con conservación de la salud periodontal y periapical de los dientes involucrados.

Chronic insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series.

BACKGROUND: Chronic insomnia and obstructive sleep apnea are both common sleep disorders. Chronic insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other's response to treatment; they interact. This report of three cases describes patients with both chronic insomnia and obstructive sleep apnea in whom the chronic insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement. CASE PRESENTATIONS: Our three Caucasians patients each presented with severe, chronic insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, chronic insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively. CONCLUSIONS: These three cases lend support to the hypothesis that chronic insomnia and obstructive sleep apnea share a pathophysiology of chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when chronic insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in chronic stress that causes the patient's chronic insomnia to remit.

Estado cualitativo y cuantitativo óseo generalizado enla osteonecrosis de maxilares. Efecto de los bifosfonatos / Qualitative and quantitative status of general bonein osteonecrosis of the jaws. Effect of bisphosphonates

OBJETIVO: La osteonecrosis de maxilares (ONM) es una enfermedad recientemente descrita cuya etiopatogenia es desconocida, aunque se ha atribuido, entre otras causas, al tratamiento prolongado con bifosfonatos. Sin embargo, mientras que la ONM es una patología localizada, la acción de los bifosfonatos es generalizada, es decir, afecta a todos los huesos. No hay estudios que muestren el estado óseo general de los pacientes con ONM. Con este trabajo hemos querido estudiar en pacientes afectos de ONM dicho estado general mediante medidas cuantitativas y estimaciones cualitativas del hueso por medio de la densidad mineral ósea (DMO) y el trabecular bone score (TBS) y los parámetros ultrasonográficos en el calcáneo (QUS), además de la presencia de otras enfermedades y la toma de fármacos (especialmente los bifosfonatos) en los pacientes con ONM que pudieran participar en su etiopatogenia. MATERIAL Y MÉTODO: Estudio observacional y transversal de casos y controles, realizado en 304 pacientes de ambos sexos, en los que el grupo de casos (grupo I) estaba formado por 24 pacientes que habían sufrido una ONM, mientras que el grupo control (grupo II) estaba formado por 280 pacientes que no presentaban ONM y que recibían bifosfonatos desde un mínimo de 5 años por causas diversas. A todos ellos se les realizó una densitometría ósea (DXA, Hologic 4500 Discovery®) en la columna lumbar y en la extremidad proximal del fémur. Además, se les realizó mediciones del TBS en la columna lumbar, así como de los parámetros ultrasonográficos en el calcáneo (Hologic, Sahara®) en el pie dominante (QUS). RESULTADOS: Los pacientes afectos de ONM tenían una mayor comorbilidad que los controles, con una mayor prevalencia de las siguientes enfermedades: diabetes mellitus, cáncer, artritis reumatoide, hipertiroidismo, cardiopatía, arritmias, insuficiencia cardíaca e hipercolesterolemia. Por ello, el consumo de corticoides, (orales e inhalados), anticoagulantes, hipnóticos, bifosfonatos i.v. (zoledronato), y quimioterapia antineoplásica fue también mayor entre los pacientes afectos de ONM que los pacientes controles. Sin embargo, entre los pacientes con ONM el porcentaje que tomaba bifosfonatos orales fue menor. Los valores densitométricos (DMO medida en la columna lumbar L2-L4, cuello femoral y total de cadera) fueron más elevados en los pacientes con ONM en comparación con los de los controles. El TBS no mostró diferencias estadísticamente significativas entre ambos grupos, y los ultrasonidos presentaron valores más elevados de QUI y SOS en los pacientes con ONM que en los controles. La prevalencia de fracturas por fragilidad fue similar en ambos grupos. CONCLUSIONES: Nuestros pacientes afectos de ONM mostraron una mayor comorbilidad y un mayor consumo de fármacos que los pacientes del grupo control, a excepción de bifosfonatos orales. Por otro lado, tanto la DMO como los parámetros ultrasonográficos mostraron valores más elevados en los pacientes con ONM que los controles. Si consideramos la DXA como una técnica medidora de la cantidad de masa ósea, y el TBS y la ultrasonografía de calcáneo técnicas estimadoras de aspectos cualitativos del hueso, podemos suponer que ni la cantidad ni la calidad óseas en general parecen estar afectadas en la ONM, siendo probablemente otro su mecanismo etiopatogénico. Los bifosfonatos orales no parecen estar entre los fármacos que participen en la etiología de la ONM, aunque sí los bifosfonatos más potentes que se administran por vía intravenosa, si bien no pueden considerarse independientemente de la patología subyacente para la cual se administran

OBJECTIVE: Osteonecrosis of the jaw (ONJ) is a recently reported disease whose origin and development are unknown, although prolonged bisphosphonate treatment has been attributed, among other causes. While ONJ is a localized condition, the action of bisphosphonates is widespread and affects all bones. No studies show the general bone status of patients with ONJ. Our study examines the general condition in patients with ONJ using quantitative measurements and qualitative estimates of bone by means of bone mineral density (BMD) and trabecular bone score (TBS) and ultrasound parameters in the calcaneus (QUS), along with other diseases and the taking of drugs (especially bisphosphonates) in patients with ONJ who may be involved in the pathogenesis. MATERIAL AND METHOD: Observational and cross-sectional study of cases and controls, conducted in 304 patients of both sexes, in which the case group (group I) was formed by 24 patients who had suffered ONJ. The control group (group II) contained 280 patients who did not present ONJ and who received bisphosphonates over at least 5 years for various reasons. All of them underwent bone densitometry (DXA, Hologic 4500 Discovery®) in the lumbar spine and proximal femur. In addition, TBS measurements were made in the lumbar spine, as well as ultrasound parameters in the calcaneus (Hologic, Sahara®) in the dominant foot (QUS). RESULTS: Patients suffering ONJ presented greater comorbidity than controls, with a higher prevalence of diabetes mellitus, cancer, rheumatoid arthritis, hyperthyroidism, heart disease, arrhythmias, heart failure and hypercholesterolemia. Therefore, the consumption of corticosteroids, (oral and inhaled), anticoagulants, hypnotics, bisphosphonates i.v. (zoledronate), and antineoplastic chemotherapy was also higher among patients with ONJ than control patients. However, among the patients with ONJ the percentage taking oral bisphosphonates was lower. Densitometric values (BMD measured in lumbar spine L2-L4, femoral neck and total hip) were higher in patients with ONJ compared to those in controls. The TBS showed no statistically significant differences between the two groups, and the ultrasound showed higher values of QUI and SOS in patients with ONJ than in controls. The prevalence of fragility fractures was similar in both groups. CONCLUSIONS: Patients with ONJ in our study presented greater comorbidity and a higher consumption of drugs than the patients in the control group, except for oral bisphosphonates. On the other hand, both BMD and ultrasound showed higher values in patients with ONJ than in controls. If we consider DXA as a technique for measuring the amount of bone mass, and TBS and calcaneal ultrasound estimating qualitative aspects of bone, we could assume that neither bone quantity nor quality in general seems to be affected in ONJ, and that its etiopathogenic mechanism is probably another. Oral bisphosphonates do not appear to be among the drugs involved in ONJ's origin and development, but the most potent and intravenously administered bisphosphonates are, although they cannot be considered independently of the underlying disease for which they are administered

Maxillary Giant Cell Granuloma: A Long-Term Follow-Up.

This is a case of a 32-year-old female with a known diagnosis of Turner syndrome who presented with complaints of chronic progressive right-sided facial pain and sinus pressure, and who was afebrile. On physical examination, there was eye proptosis on the right and significant increased fullness in the right infraorbital and maxillary regions. Computed tomography and magnetic resonance imaging demonstrated a large expansile space-occupying lesion in the right maxillary area, that histologically turned out to be a giant cell reparative granuloma. The lesion was completely removed and of interest, the patient was followed up both clinically and on imaging for 10 years with no signs of recurrence. A discussion on this entity, as well the clinical and imaging differential diagnoses, is carried out.

Central giant cell granuloma - A case report.

Central giant cell granuloma (CGCG) of the jaws is a benign, intraosseous, osteolytic lesion of debatable etiology. CGCG lacks in clinical and radiographical pathognomonic features to distinguish from common lesions occurring in this region. Histopathology still remains the predominant diagnostic modality to identify the disorder. Clinically aggressive lesions and atypical lesions can lead to early damage and may necessitate aggressive therapy to prevent recurrences. A case of an aggressive type of CGCG of the maxilla in a young adult male patient with diagnostic and treatment challenge is presented.

Idiopathic osteosclerosis in the maxillomandibular area.

OBJECTIVES: To test a more complete set of morphometric radiographic parameters to evaluate the idiopathic osteosclerosis (IO) lesions located in the maxillomandibular area and to know their features during routine radiographic evaluation. MATERIALS AND METHODS: Radiographs from patients attending the oral diagnosis clinic of our institution were reviewed. Evaluated parameters were gender and age of the patients, size, side, homogeneity, morphology, radiodensity, mineralization, borders, relation to roots, affected tooth or teeth and location of the analyzed lesions. RESULTS: Of the 6340 assessed patients, 354 (5.6%) harbored 362 lesions. IOs were more common during 2nd to 4th decades (mean age = 39 years). IO frequency rose from 1st to 3rd decades and then decreased. Size varied from 0.1 to 5.8 cm, and its frequency increased from 7 to 30 years age and then decreased too. The mandible and molar region were more commonly affected. Radiopaque image, radicular location, round shape, homogeneous core and well-defined boundaries were the more frequent IO features. CONCLUSIONS: Our method allows to analyze IO lesions with precise parameters. Analysis of the results does not support the previously suggested theories to explain their origin, and these figures suggest that the so-called IOs are developmental alterations of the bone.