Gingival Myofibroma. A case report.

AIM: The Myofibroma (MF) is a benign mesenchymal tumor frequently observed in the skin and subcutaneous tissue of the head-neck region. It is described mainly in infants with congenital forms and, in early childhood, with acquired forms. Less often, it can be observed in adolescents and adults. The location of a MF in the oral cavity is occasional and differential diagnosis must be established with other benign and malignant neoplasms, high or low grade, of the oral mucosa. The histology of the myofibroma shows a biphasic growth pattern: elongated spindle cells with eosinophilic cytoplasm, in the borders, polygonal cells arranged in a palisading pattern, with hyperchromatic nuclei, in the central portions. The diagnosis of MF, usually made after excision of the neoformation, is obtained by means of immunohistochemistry, in which there is positivity for vimentin and αactine smooth muscle antibodies and negativity for keratin, S-100, EMA (Epithelial Membrane Antigen) antibodies. The treatment is surgical; the prognosis is generally good with low rates of recurrence after excision. CASE REPORT: The authors describe a case of MF in a 16-year-old male subject, that came to their observation for the growth of a considerable mass attached to the gingival mucosa, describing the therapeutic strategy.

Necrotizing fasciitis of the maxillofacial region caused by dental infection. A case report and review.

Necrotizing fasciitis (NF) is a destructive and potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in subcutaneous tissues and fascia, with serious involvement of muscles, vessels, nerves, and fat. In the maxillofacial region, NF is less common. The process can represent the evolution of a dental infection supported by aerobic and anaerobic bacteria that are resistant to antibiotic therapy (multidrug resistance) in immunocompromised patients or the natural evolution of untreated infection. Because of the rarity of the disease, diagnosis and treatment are often delayed, which may result in a fatal outcome due to respiratory problems or systemic complications. The success of the treatment is surgical debridement and high doses of antibiotic therapy. The AA described a case of NF in a female, 59 years old, who developed NF in the maxillofacial and neck region following dental infection and after consulting our Institute for remarkable swelling of the right cheek, palpebral and parotid regions, submaxillary region, and neck; this swelling is associated with hyperpyrexia, trismus, poor systemic conditions, and serious respiratory difficulty. Through prompt clinical diagnosis, early surgical treatment, appropriate antibiotic therapy (culture analysis revealed sensitivity to Imipenem and Levofloxacina), and local control of the lesion through surgical medications twice daily, we were able to not only avoid serious and fatal evolution of the process, but also to limit tissue involvement, preventing further extension of the necrosis to other anatomical structures of the region. A satisfactory clinical result was thus obtained.