ABSTRACT
An 81-year-old male patient presented with a well-demarcated, unilocular radiolucent lesion in the right mandibular body, identified during a routine radiographic examination. Based on the clinical hypothesis of a residual cyst, enucleation with curettage was performed, and the specimen was submitted for histopathological analysis. Microscopically, the cystic lesion was predominantly lined by ameloblastomatous epithelium with numerous ghost cells and dentinoid. Additionally, other cystic cavities lined by stratified squamous epithelium with corrugated parakeratin were observed in the fibrous capsule. Based on these features, a final diagnosis of a calcifying odontogenic cyst with odontogenic keratocyst-like areas was established. No recurrence was observed over a 9-year follow-up period. The association of a calcifying odontogenic cyst with odontogenic keratocyst or odontogenic keratocyst-like areas is very rare. To date, this is the second case report in the literature presenting these findings.
Subject(s)
Odontogenic Cyst, Calcifying , Humans , Male , Aged, 80 and over , Odontogenic Cyst, Calcifying/pathology , Odontogenic Cyst, Calcifying/diagnosis , Mandibular Diseases/pathology , Mandibular Diseases/diagnosis , Odontogenic Cysts/pathologyABSTRACT
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.
Subject(s)
Dentigerous Cyst , Mucopolysaccharidosis I , Humans , Dentigerous Cyst/surgery , Dentigerous Cyst/diagnosis , Mucopolysaccharidosis I/complications , Mucopolysaccharidosis I/diagnosis , Mucopolysaccharidosis I/therapy , Male , Mandibular Diseases/surgery , Mandibular Diseases/diagnosis , FemaleABSTRACT
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.
Subject(s)
Cone-Beam Computed Tomography , Diagnostic Errors , Odontogenic Cysts , Humans , Aged , Male , Odontogenic Cysts/diagnosis , Odontogenic Cysts/pathology , Odontogenic Cysts/surgery , Mandibular Diseases/diagnosis , Mandibular Diseases/surgery , Mandibular Diseases/diagnostic imaging , Mandibular Diseases/pathology , Periapical Diseases/diagnosis , Periapical Diseases/diagnostic imaging , Periapical Diseases/pathologyABSTRACT
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.
Subject(s)
Mandibular Diseases , Odontogenic Cysts , Humans , Child , Mandibular Diseases/diagnosis , Mandibular Diseases/surgery , Mandibular Diseases/pathology , Odontogenic Cysts/diagnosis , Odontogenic Cysts/surgery , Odontogenic Cysts/pathology , Periodontal Pocket , Molar/pathologyABSTRACT
RESUMEN El ameloblastoma es un tumor odontogénico benigno, localmente agresivo y recidivante, con predilección por la región posterior de la mandíbula. Se caracteriza por su agresividad local con muy baja tendencia a metastizarse. El objetivo fue reportar el caso clínico de un paciente con ameloblastoma multiquístico derecho, tratado a través de hemimandibulectomía. Se presentó un paciente masculino, de 44 años de edad, que refirió aumento de volumen del lado derecho de la mandíbula desde hacía aproximadamente un año, acompañado también de otros síntomas, atendido en el Servicio de Cirugía Maxilofacial del Hospital Militar Principal/Instituto Superior, en Luanda, Angola. Los estudios imagenológicos incluyeron radiografía panorámica y tomografía axial computarizada. El diagnóstico clínico patológico fue de ameloblastoma multiquístico. Este tipo de tumor requiere de un adecuado diagnóstico sobre la base de la presentación clínica, localización, tamaño, edad y tipo histológico; de ahí la importancia de conocer las características clínicas e imagenológicas, pues el tratamiento conlleva gran dificultad (AU).
ABSTRACT Ameloblastoma is a benign odontogenic tumor, locally aggressive and recidivist with predilection for back of the jaw, characterized by local aggressiveness and low tendency to metastasize. The aim was reporting the clinical case of a patient with right multicystic ameloblastoma treated through hemimandibulectomy. We presented a male patient aged 44 years, who referred a volume increase of the jaw right side for around a year, accompanied also by other symptoms; he attended the Maxillofacial Surgery Service of the Main Military Hospital/High Institute of Luanda, in Angola. The image studies included panoramic radiography and computerized axial tomography the clinical pathological diagnosis was multicystic ameloblastoma. This kind of tumor requires an adequate diagnosis based on the clinical presentation, location, size, age and histological kind, therefore the importance of knowing the clinical and image characteristics, because the treatment is very difficult (AU).
Subject(s)
Humans , Male , Adult , Ameloblastoma/surgery , Mandibular Osteotomy/methods , Biopsy/methods , Ameloblastoma/complications , Ameloblastoma/diagnosis , Mandibular Diseases/diagnosis , Odontogenic Tumors/surgery , Odontogenic Tumors/diagnosis , Clinical DiagnosisABSTRACT
Abstract Objective Orthokeratinized odontogenic cyst is a rare developmental odontogenic cyst of the jaws. It is a less aggressive intraosseous cyst identified by an orthokeratinized epithelium. Case Report A 50-year-old male patient with the chief complaint of swelling in the anterior part of his face, and, intraorally, there was diffuse swelling in the palatal cortex. On panoramic radiography, there was a well-defined unilocular radiolucency on the right side of the maxilla and palatal cortical expansion, and thinning of the buccal and palatal cortexes was observed. The histopathological examination revealed a pathologic cyst that was lined by a thick orthokeratinized epithelium. Therefore, the diagnosis was orthokeratinized odontogenic cyst. Conclusion The orthokeratinized odontogenic cyst displays characteristic clinical, histopathological, and biological features that differ significantly from those of keratocystic odontogenic tumor (KCOT), but it has a better prognosis and lower recurrence rate. Thus, other radiolucent lesions of the jaws, including keratocystic odontogenic tumor (KCOT), must be considered in the differential diagnosis.
Resumo Objetivo O cisto odontogênico ortoceratinizado é um raro cisto odontogênico maxilar. É um cisto intraósseo menos agressivo, identificado por um epitélio ortoceratinizado. Relato de caso Um paciente do sexo masculino, de 50 anos de idade, com queixa principal de edema na parte anterior da face, e, intraoralmente, havia edema difuso no córtex palatal. Na radiografia panorâmica, havia uma radioluminescência unilocular bem definida no lado direito da maxila e expansão cortical palatina, e desbastamento dos córtex vestibular e palatino. O exame histopatológico revelou cisto patológico revestido por espesso epitélio ortoceratinizado. Logo, o dignóstico foi de cisto odontogênico ortoceratinizado. Conclusão O cisto odontogênico ortoceratinizado apresenta características clínicas, histopatológicas e biológicas que diferem significativamente das do tumor odontogênico ceratocístico (TOC), mas tem melhor prognóstico e menor taxa de recorrência. Portanto, outras lesões radiolúcidas dos maxilares, incluindo TOC, devem ser consideradas no diagnóstico diferencial.
Subject(s)
Humans , Male , Female , Odontogenic Cysts/diagnosis , Odontogenic Cysts/physiopathology , Jaw/injuries , Mandibular Diseases/diagnosis , Maxillary Diseases/diagnosisABSTRACT
Juvenile mandibular chronic osteomyelitis (JMCO) is a rare, idiopathic disease of chronic bone inflammation without suppuration, sinus tract formation, or sequestration. As the name suggests, this condition predominately affects children. The few cases of JMCO reported in the literature describe different treatments, and thus a standard therapy protocol has not yet been established. The aim of this paper is to report a clinical case in a 9-year-old girl that was misdiagnosed and unsuccessfully treated for 1 year. After experiencing persistent symptoms, a correct diagnosis was subsequently rendered based on the physical and radiographic examination as well as successful treatment with non-steroidal anti-inflammatory drugs (NSAIDs). The patient received drug therapy followed by periods of remission over a 4 year follow-up period. Diagnosis and treatment of JMCO is a challenge given the rarity and nonspecific signs and symptoms of this condition. Treatment with NSAIDs and regular follow-up is a conservative option for these patients.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Indomethacin/therapeutic use , Mandibular Diseases/diagnosis , Osteomyelitis/diagnosis , Anti-Bacterial Agents/therapeutic use , Child , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Diagnostic Errors , Female , Humans , Mandibular Diseases/drug therapy , Mumps/diagnosis , Mumps/drug therapy , Osteomyelitis/drug therapy , Parotitis/diagnosis , Parotitis/drug therapyABSTRACT
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.
Subject(s)
Granuloma, Giant Cell/diagnosis , Mandibular Diseases/diagnosis , Child , Granuloma, Giant Cell/pathology , Granuloma, Giant Cell/surgery , Humans , Mandibular Diseases/pathology , Mandibular Diseases/surgery , Referral and ConsultationABSTRACT
Introduction: The odontogenic keratocyst was recently reclassified in 2017 by the World Health Organization as a cystic lesion of epithelial development derived from the enamel organ or the dental lamina. It shows common characteristics to cysts such as slow and continuous growth; however, it arouses attention for its high aggressiveness and recurrence rate. Objective: To show marsupialization followed by enucleation as a definitive treatment of odontogenic keratocysts. Clinical case: A 63-year-oldwoman with odontogenic keratocyst on the left side of the mandible, treated by the marsupialization technique followed by enucleation. Conclusions: Although there are various treatment options, the dental surgeon may prefer the conservative method in the approach of the odontogenic keratocyst, because it presents the lowest rate of morbidity and relapse within the standards presented in the literature(AU)
Introducción: el queratoquiste odontogénico fue reclasificado en 2017 por la Organización Mundial de la Salud como una lesión cística de desarrollo epitelial, derivado del órgano del esmalte o de la lámina dental. Presenta características comunes a quistes, como crecimiento lento y continuo, sin embargo, llama la atención por su alta agresividad y tasa de recurrencia. Objetivo: describir la marsupialización seguida de enucleación como un tratamiento definitivo para el queratoquiste odontogénico. Presentación del caso: mujer de 63 años con queratoquiste odontogénico en el lado izquierdo de la mandíbula, tratado por la técnica de marsupialización seguido de enucleación. Conclusiones: a pesar de diferentes opciones de tratamientos existentes, el método conservador puede ser el tratamiento de elección del cirujano-dentista en el abordaje del queratoquiste odontogénico, pues presenta la menor tasa de morbilidad y recidiva dentro de los patrones mostrados en la literatura(AU)
Subject(s)
Humans , Female , Middle Aged , Surgery, Oral/methods , Mandibular Diseases/diagnosis , Odontogenic Cysts/therapyABSTRACT
Introduction: The odontogenic keratocyst was recently reclassified in 2017 by the World Health Organization as a cystic lesion of epithelial development derived from the enamel organ or the dental lamina. It shows common characteristics to cysts such as slow and continuous growth; however, it arouses attention for its high aggressiveness and recurrence rate. Objective: To show marsupialization followed by enucleation as a definitive treatment of odontogenic keratocysts. Clinical case: A 63-year-oldwoman with odontogenic keratocyst on the left side of the mandible, treated by the marsupialization technique followed by enucleation. Conclusions: Although there are various treatment options, the dental surgeon may prefer the conservative method in the approach of the odontogenic keratocyst, because it presents the lowest rate of morbidity and relapse within the standards presented in the literature(AU)
Introducción: el queratoquiste odontogénico fue reclasificado en 2017 por la Organización Mundial de la Salud como una lesión cística de desarrollo epitelial, derivado del órgano del esmalte o de la lámina dental. Presenta características comunes a quistes, como crecimiento lento y continuo, sin embargo, llama la atención por su alta agresividad y tasa de recurrencia. Objetivo: describir la marsupialización seguida de enucleación como un tratamiento definitivo para el queratoquiste odontogénico. Presentación del caso: mujer de 63 años con queratoquiste odontogénico en el lado izquierdo de la mandíbula, tratado por la técnica de marsupialización seguido de enucleación. Conclusiones: a pesar de diferentes opciones de tratamientos existentes, el método conservador puede ser el tratamiento de elección del cirujano-dentista en el abordaje del queratoquiste odontogénico, pues presenta la menor tasa de morbilidad y recidiva dentro de los patrones mostrados en la literatura(AU)
Subject(s)
Humans , Female , Middle Aged , Surgery, Oral/methods , Mandibular Diseases/diagnosis , Odontogenic Cysts/therapyABSTRACT
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.
Subject(s)
Humans , Male , Child , Mandibular Diseases/surgery , Mandibular Diseases/pathology , Mandibular Osteotomy/methods , Hyperplasia/surgery , Mandibular Diseases/diagnosis , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
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.
Subject(s)
Humans , Female , Middle Aged , Osteomyelitis/diagnosis , Mandibular Diseases/diagnosis , Osteomyelitis/surgery , Osteomyelitis/drug therapy , Osteonecrosis/diagnosis , Periapical Abscess/diagnosis , Suppuration , Radiography, Panoramic , Mandibular Diseases/surgery , Mandibular Diseases/drug therapy , Tomography, X-Ray Computed , Chronic Disease , Dental Fistula/diagnosis , Debridement , Controlled Before-After Studies , Anti-Bacterial Agents/therapeutic useABSTRACT
Periapical lesions usually are caused by root canal infection; nevertheless, other pathologies may eventually involve the tooth apex, making the correct diagnosis more difficult. Glandular odontogenic cysts (GOCs) are uncommon and, despite their cystic nature, may present an aggressive behavior and a high recurrence rate. This report describes a recurrent GOC mimicking a periapical lesion that was followed up for 20 years. A 45-year-old woman described tooth discomfort for several years in the anterior region of the mandible that was not exacerbated during eating or occlusion. Clinical examination revealed no signs of swelling, redness, or inflammation in the gingival or surrounding soft tissue. Nevertheless, periapical radiography showed a well-defined large radiolucent lesion in the periapical region of teeth #22, #23, #24, and #25. The pulp test confirmed that all these teeth were vital. An incisional biopsy was performed, and with the histopathological diagnosis of an odontogenic cyst, the lesion was enucleated surgically. After recurrence, the extensive periapical multilocular lesions were again surgically removed. Based on the microscopic findings, the final diagnosis was GOC. One year later, there were no signs of recurrence. GOCs associated with the root apex may mimic periapical inflammatory diseases. Clinical, radiographic, and histopathological findings are essential for the diagnosis of inconclusive radiolucent findings in the periapical region. Biopsy specimens should be sent to a specialized oral pathology laboratory.
Subject(s)
Mandibular Diseases/diagnosis , Odontogenic Cysts/diagnosis , Periapical Diseases/diagnosis , Biopsy , Female , Follow-Up Studies , Humans , Mandibular Diseases/diagnostic imaging , Mandibular Diseases/pathology , Middle Aged , Odontogenic Cysts/diagnostic imaging , Odontogenic Cysts/pathology , Periapical Diseases/diagnostic imaging , Periapical Diseases/pathology , Radiography, Dental , Radiography, PanoramicABSTRACT
BACKGROUND: Chorea acanthocytosis is an extremely rare neurodegenerative condition characterized by neuropsychiatric disturbances, movement disorders, neuropathy, seizures, and acanthocytosis. In this case report, the authors will present the management of the oromandibular movement disorders associated with this disease. CASE DESCRIPTION: This case report describes the focal management of the severe orofacial manifestations associated with this condition. The therapeutic approach adopted to reduce the severe oromandibular movements, dysphagia, and the numerous oral ulcers was selective electromyography (EMG)-guided botulinum toxin application to the inferior head of the lateral pterygoid muscles and masseters. This would be applied to control severe and sudden oromandibular dystonia. RESULTS: Through this procedure, the authors were able to reduce these severe oral manifestations, which had a major impact on the patient's quality of life, and temporarily improve vital functions, such as mastication, deglutition, and speech articulation. CONCLUSIONS: Electromyography-guided botulinum toxin application may be a useful tool in the multimodal management of this condition.
Subject(s)
Botulinum Toxins/administration & dosage , Dystonia/therapy , Electromyography , Mandibular Diseases/therapy , Neuroacanthocytosis/therapy , Adult , Dystonia/diagnosis , Electromyography/drug effects , Female , Follow-Up Studies , Humans , Injections, Intramuscular , Mandibular Diseases/diagnosis , Masseter Muscle/drug effects , Neuroacanthocytosis/diagnosis , Oral Ulcer/diagnosis , Oral Ulcer/therapy , Pterygoid Muscles/drug effectsABSTRACT
To compare two types of treatment for Class II deep overbite malocclusion assessing maxillary and mandibular arches behavior in subjects submitted to full orthodontic treatment with standard edgewise appliance and those who used straight wire appliance. METHODS: The sample consisted of 50 patients treated with full fixed appliances either with edgewise appliance n=25, Group 1, or with straight wire appliance n=25, Group 2. In both groups lateral cephalometric radiographs were compared with those done at the beginning of treatment and at its end, in order to quantify the cephalometric measures 8 linear and 6 angular presenting the maxillary and mandibular arches behavior in the anteroposterior and vertical directions. All patients were treated without extraction or use of Class II intermaxillary elastics during the full orthodontic treatment. RESULTS: In both groups the treatment of malocclusion contributed for mandibular forward displacement, reduction of deep overbite and overjet, reduction of mandibular plane with anti-clockwise rotation and labial projection of maxillary incisors. CONCLUSIONS: In both groups the sample showed favorable mandibular displacement, reduction of facial convexity, and profile improvement with anti-clockwise rotation. The correction of deep overbite was due to labial projection and intrusion of maxillary incisors...
Subject(s)
Humans , Male , Female , Cephalometry , Mandibular Diseases/diagnosis , Malocclusion , Mandible , Maxilla , Orthodontic Appliances , Overbite , Orthodontics/instrumentationABSTRACT
An unusual presentation of a focal osteoporotic bone marrow defect (FOBMD) of the mandible mimicking a cystic lesion is documented. A definitive diagnosis could be established only on the basis of the histopathologic evaluation. A 66-year-old Brazilian woman was referred by her dentist for well-defined radiolucency of the mandibular molar region suggesting a cystic lesion of odontogenic origin. The computed tomography scan confirmed that the lesion did not affect the corticals. The biopsy confirmed the diagnosis of FOBMD. The diagnostic difficulty in the current case is obvious, because FOBMD, usually exhibiting an ill-defined radiolucency, is seldom suspected preoperatively when a differential diagnosis is considered for focal well-defined radiolucent areas in the jaws.
Subject(s)
Bone Marrow Diseases/diagnosis , Cysts/diagnosis , Mandibular Diseases/diagnosis , Osteoporosis/diagnosis , Aged , Diagnosis, Differential , Female , HumansABSTRACT
Central giant cell granuloma (CGCG) of the jaws represents a localized and benign neoplastic lesion sometimes characterized by aggressive osteolytic proliferation. The World Health Organization defines it as an intraosseous lesion composed of cellular and dense connective tissues that contain multiple hemorrhagic foci, an aggregation of multinucleated giant cells, and occasional bone tissue trabeculae. The origin of this lesion is uncertain; however, factors such as local trauma, inflammation, intraosseous hemorrhage, and genetic abnormalities have been identified as possible causes. CGCG generally affects those younger than 30 years and occurs more frequently in women (2:1). This lesion corresponds to approximately 7% of all benign tumors of the jaws, with prevalence in the anterior region of the jaw. Aggressive lesions are characterized by symptoms, such as pain, numbness, rapid growth, cortical perforation, root resorption, and a high recurrence rate after curettage. In contrast, nonaggressive CGCGs have a slow rate of growth, may contain sparse trabeculation, and are less likely to move teeth or cause root resorption or cortical perforation. Nonaggressive CGCGs are generally asymptomatic lesions and thus are frequently found on routine dental radiographs. Radiographically, the 2 forms of CGCG present as radiolucent, expansive, unilocular or multilocular masses with well-defined margins. The histopathology of CGCG is characterized by multinucleated giant cells, surrounded by round, oval, and spindle-shaped mononuclear cells, scattered in dense connective tissue with hemorrhagic and abundant vascularization foci. The final diagnosis is determined by histopathologic analysis of the biopsy specimen. The preferred treatment for CGCG consists of excisional biopsy, curettage with a safety margin, and partial or total resection of the affected bone. Conservative treatments include local injections of steroids, calcitonin, and antiangiogenic therapy. Drug treatment using antibiotics, painkillers, and corticosteroids and clinical and radiographic monitoring are necessary for approximately 10 days after surgery. There are only a few cases of spontaneous CGCG regression described in the literature; therefore, a detailed case report of CGCG regression in a 12-year-old boy with a 4-year follow-up is presented and compared with previous studies.
Subject(s)
Granuloma, Giant Cell/diagnosis , Mandibular Diseases/diagnosis , Biopsy/methods , Child , Collagen/analysis , Diagnosis, Differential , Erythrocytes/pathology , Fibrous Dysplasia of Bone/diagnosis , Follow-Up Studies , Giant Cells/pathology , Humans , Male , Mesoderm/pathology , Remission, SpontaneousABSTRACT
En la población joven venezolana las maloclusiones representan un importante problema de salud bucal. Resulta útil la aplicación de métodos diagnósticos cefalométricos como el propuesto por Petrovic que permitan identificar el potencial de crecimiento mandibular del paciente como un instrumento para seleccionar la modalidad de tratamiento. El propósito de esta investigación fue identificar los grupos rotacionales y las categorías auxológicas en pacientes venezolanos, de ambos géneros, entre 7 y 10 años, que acudieron a la Facultad de Odontología de la UCV, durante el periodo 2006-2010. Se aplicó el método cefalométrico de Petrovic para la identificación del tipo rotacional y categoría auxológica en las radiografías cefálicas laterales de pacientes sin tratamiento ortopédico ni ortodóncico previo. El tipo rotacional más frecuente fue el P1N, seguido por R2D, R1N y P2D; en ambos géneros el tipo rotacional P1N fue el más frecuente, sin embargo en el género femenino, también se observaron los tipos P2D, R2D y R1N. El grupo rotacional más frecuente fue P1NOB y en segundo lugar R1NOB. Los grupos rotacionales P1NOB y R1NOB fueron los más frecuentes en las niñas y P1NOB en los niños. La determinación del tipo rotacional y la categoría auxológica es una herramienta diagnóstica importante para orientar el plan de tratamiento más acorde según el potencial de crecimiento del paciente...
In the young venezuelan population, malocclusions are an important oral health problem. It is useful the application of cephalometric diagnostic methods as the proposed by Petrovic that allows to identify the mandibular growth potential of the patient as a tool to select the appropriate treatment modality. The aim of this study was to identify the rotational auxologic groups and categories in Venezuelan patients for both genders, age between 7 and 10 years, who had been attended in the Faculty of Dentistry of the Universidad Central of Venezuela, during the period 2006-2010. Was applied Petrovic cephalometric method for identifying the rotational type and auxologic category in the cephalic lateral radiographs of patients without previous orthodontic or orthopedic treatment. The most frequent rotational type was P1N, followed by R2D, R1N and P2D; in both genders P1N rotational type was the most common, however in the female gender, P2D, and R2D and R1N types were also observed. The most frequent rotational group was P1NOB and secondly R1NOB. R1NOB and P1NOB were rotational groups most frequent in girls and in boys was P1NOB. The determination of the rotational type and auxologic category is important to guide the treatment plan according to the patient's growth potential...