Primary intra-osseous Hybrid Schwannoma-Perineurioma in the mandible.

Benign nerve sheath tumours include perineuriomas, schwannomas and neurofibromas. Hybrid schwannoma-perineurioma represents a cutaneous, subcutaneous or occasionally intra-osseous tumour with schwannian cytomorphology and perineurioma-like architecture consisting of a mixture of both types of cells. These tumours can develop at any age and there is no gender-predilection. Tongue is the most frequently affected site, followed by palate, mouth floor, jugal mucosa, lips and, more rarely, mandible. We present a case of hybrid tumour with schwannoma-perineurioma morphology located on the right mandibular body (intra-osseous) of a 54-year-old female patient. The tumour was symptomatic and evolving for six months. Microscopically, it was encapsulated and highly cellularised, presenting fascicular aspect and exhibiting scant mitotic activity. The tumour consisted of distinct cellular populations involving fusiform cells, cells with wavy and hyperchromatic nucleus or even epithelioid cells. Positive immunostaining for S-100 and epithelial membrane antigen (EMA) was observed. The lesion was completely removed under general anaesthesia, with the patient showing no clinical or radiographic sign of relapse after two-year follow-up. Despite the limited knowledge on the pathogenesis of Hybrid Schwannoma-Perineurioma, these tumours seem to present a non-aggressive biological behaviour. Conservative surgery provides adequate solution without recurrence, even after a long-term follow-up. Key words:Nerve sheath tumours, Schwannoma, Perineurioma, Immunohistochemistry.

Marsupialization before enucleation as a treatment strategy for a large calcifying odontogenic cyst: Case report.

INTRODUCTION: Odontogenic pathological lesions can generally be divided into cysts and tumors. Calcifying odontogenic cyst (COC) is a non-aggressive odontogenic cyst, however, in a few occasions, COC can show excessive growth and destruction. This study describes an uncommon aggressive presentation of a large COC and discusses the treatment strategies used to achieve a favorable result. PRESENTATION OF CASE: A 11-year-old child sought treatment for a painless growth on his mandible that caused facial asymmetry. On clinical and imaging examination, a large radiolucent lesion was observed in a panoramic x-ray involving the right side of the mandible. Radiopaque areas were observed within the lesion. Treatment comprised of an initial marsupialization followed by surgical removal of the lesion. Follow up extended for more than 10 years and no signs of recurrence were observed. DISCUSSION: Initial marsupialization was successfully employed in order to decrease the lesion, inducing bone formation, and reducing the risk of mandibular fracture and inferior alveolar nerve damage. Four months after marsupialization, the lesion substantially reduced its volume and enucleation with peripheral ostectomy was carried out. This approach allowed a safer surgical removal of the lesion and achieve an excellent result. CONCLUSION: Although some authors consider marsupialization as an unnecessary step that delays final treatment, when well indicated, it facilitates surgical treatment, promotes and preserves normal tissues, reduces the necessity of surgical reconstruction and costs, yet showing excellent results.

Cone beam computed tomography diagnostic imaging of intra-osseous mucoepidermoid carcinoma in the mandible.

Intra-osseous mucoepidermoid carcinoma in the mandible is a rarely reported entity, comprising only 2-3% of all mucoepidermoid carcinomas. Unilocular and/or multilocular radiolucency is characteristic of mucoepidermoid carcinoma, but has a radiographic appearance similar to that of odontogenic benign and malignant tumors and thus cannot be accurately diagnosed on plain films. This article describes a case of a 36-year-old man with intra-osseous mucoepidermoid carcinoma in the left mandible. For a detailed analysis, both panoramic radiograph and cone beam computed tomograph were taken. Important clinico-pathological and imaging features, differential diagnosis and review of the literature are described. Key words:Diagnosis, Cone Beam Computed Tomography, Head and Neck Tumors.

Bisphosphonate-Related Osteonecrosis of the Jaws and Its Array of Manifestations.

PURPOSE: Bisphosphonate (BP) therapy in the treatment of bone diseases and malignancy may induce a major side effect known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). A particular view of this condition is reported in this case series investigating eight patients. The aim of the study was to evaluate the BRONJ lesions concerning their aspects and progression. Also, identify if it is possible to predict the degree of severity in these cases. METHODS: Patients were evaluated by their condition and systemic health. The lesions were evaluated in clinical and radiographic aspects. The patients were followed-up for 2 years. RESULTS: The patients presented with specific peculiarities, and the BRONJ lesions varied in several characteristics. The BRONJ lesions ranged from simple to severe conditions, and the complicated cases presented with major pain, swelling, secondary infection and an extensive necrotic area, classified with high grade of severity. CONCLUSIONS: The patients presented here confirm the existence of a relation between multiple features and BRONJ and to understand the whole process of aggravation, all systemic and local information have to be taken into account, together with all data related to the BP utilized. Regardless of the low incidence of this side effect in relation to osteoporosis treatment, in some cases, the BRONJ may become a severe condition and compromise the patient's quality of life.

Anvisa e o cirurgião-dentista: do controle de qualidade de insumos às normas de prescrição de antimicrobianos / Health agency and the dentist: antimicrobial prescription and quality control of health apparatus

O objetivo do presente trabalho é descrever e discutir as normas de prescrição de Antimicro¬bianos definidas pela Anvisa (Agência Nacional de Vigilância Sanitária], e suas atividades regu¬latórias. Sendo os Cirurgiões-Dentistas, dentre os profissionais de saúde, aptos a prescrever uma série de grupos medicamentosos, estes deverão conhecer as normas, viabilizando o uso racional de drogas. A RDC n° 44, de 26 de outubro de 2010 altera a forma de prescrição de antimicrobia¬nos, exigindo que o estabelecimento dispensador retenha cópia de receita de controle especial. A Anvisa, através da RDC n° 3, 4, e 5, de 2011, também modificou as exigências relativas à im¬portação de agulhas, dentre elas as gengivais de uso odontológico, objetivando a padronização de tais produtos em obediência às Boas Práticas de Fabricação (BPF). Os profissionais de saúde deverão estar cientes das modificações definidas pela Anvisa, a fim de garantir o maior controle na prescrição e venda de medicamentos, assim como do controle que essa Agência promove diante dos produtos de uso em saúde.

The objective of this study is to describe and discuss the limitations rules designed by Anvisa,as their regulatory activities. The dentists are able to prescribe medicines and they should be aware of the Legal Rules enabling the rational use of drugs. The Law number 44, October 26, 2010, considering the rule for antimicrobial prescription, requires the drugstore/pharmacy to dispense and to retain a copy of special control prescriptions. The Anvisa also changed the re¬quirements for needles importation, including the needles for dental use, aiming the standardi¬zation of such products in compliance with Good Manufacturing Practices. Health professionals should be aware of the changes to ensure greater control in prescribing medicines, as well as the control that this agency promotes considering the products used in Health.

Sialolito gigante de glândula submandibular: achados na tomografia computadorizada / Giant sialolith of the submandibular gland: computed tomography features

O objetivo do presente estudo é mostrar o uso da tomografia computadorizada na análise da sialolitíase. A sialolitíase é uma alteração comum das doenças de glândulas salivares causadas pela presença de cálculo no interior do ducto ou na glândula salivar. Comumente o sialolito mede de 1 mm a 35 mm ou mais, incluindo o caso clínico relatado. Mais de 80% dos cálculos salivares aparecem na glândula submandibular, porém eles ficam localizados no parênquima da glândula e no ducto excretor mais comumente. O seu diagnóstico e tratamento estão relacionados principalmente, com a sua localização. A tomografia computadorizada de feixe cônico é útil para a avaliação dimensional e localização do sialolito gigante.

The objective of the present study is to show the use of computed tomography to analyze the sialolithiasis. The sialolithiasis is the most common disease of the salivary glands caused by the presence of salivary calculus inside the duct or the salivary gland. Commonly, sialoliths measure from 1 mm to 35 mm or more, including the case reported. More than 80% of the salivary gland calculi appear in submandibular gland, but they can also be located in the glandular parenchyma and more frequently in excretory duct. Diagnosis and treatment depend on the localization of mineral calculi. The cone beam computed tomography is useful to dimensional evaluation and location of giant sialoliths.

Idiopathic thrombocytopenic purpura presenting as post-extraction hemorrhage.

AIM: The aim of this article is to present a case of idiopathic thrombocytopenic purpura (ITP) in order to emphasize the importance of the clinical exam since the anamnesis leads to a diagnostic hypothesis of ITP. BACKGROUND: Acute ITP is considered an autoimmune disease characterized by the production of antibodies against platelets, antigens produced by a viral infection, or a platelet sparing drug combination. These antibodies adhere to platelets and are recognized and destroyed by the reticulo-endothelial system. Consequently, the platelet count gradually diminishes and is insufficient for the maintenance of primary hemostasis. REPORT: A 77-year-old woman presented with post-extraction intermittent bleeding. The physical examination revealed discoloration of the skin, multiple petechiae, hematomas, ecchymosis of the upper lip, bruises all over the body, gingiva that bled spontaneously, and a malformed blood clot at the extraction site of tooth #44. The hematological exams confirmed the hypothesis of ITP. The patient was immediately hospitalized in the Hematology Department of a local hospital and received platelet replacement, hydration, medication, and general care. After the spontaneous bleeding stopped, the malformed clot was removed using alveolar curettage along with a thorough cleaning of the extraction site with a 0.9% saline solution before suturing the wound and prescribing medication. After the sixth day of hospitalization, the patient presented with the following results: Hb: 12.3 mg/dL, Ht: 36.1%, and PC: 87,000 mm3. The patient was then discharged and was placed under outpatient follow-up care. SUMMARY: The importance of the clinical exam must be emphasized since the anamnesis leads to a diagnostic hypothesis of ITP and provides the dental surgeon with an opportunity to make important systemic alterations to improve the prognosis of a patient with ITP.

Influência das pistas deslizantes na obtençäo da relaçäo central em prótese total / Influence of sliding tracks on the obtainment of centric relation in complete dentures

A relaçäo central (RC) é considerada por muitos autores como o ponto fundamental para o início da restauraçäo da articulaçäo dentária com próteses totais, e como a única referência de início e término de todos os movimentos mastigatórios. Para obtê-la é importante que haja relaxamento de toda a musculatura relacionada à fisiologia da mastigaçäo, deglutiçäo e fonética. O emprego de pistas de Nóbilo com modificaçäo sugerida por TURANO* proporciona esse relaxamento muscular, uma vez que as pistas orientaräo a movimentaçäo mandibular dos pacientes de forma harmônica em relaçäo à inclinaçäo da cavidade articular da ATM. Isso permite que os proprioceptores relembrem a real posiçäo que a mandíbula ocupava em relaçäo ao crânio, fazendo com que a mesma assuma seu padräo de centralidade (RC) original

Pênfigo vulgar: importância para o cirurgiäo dentista / Pemphigus vulgaris: its importance to the dental professional

O Pênfigo vulgar é uma patologia rara, porém apresenta lesöes na mucosa bucal antes das sistêmicas. Em razäo da importância do diagnóstico precoce do pênfigo vulgar, o profissional cirurgiäo dentista deve estar atento e familiarizado com as características clínicas dessa doença, como também, com os exames complementares para seu diagnóstico, devendo, ainda participar no tratamento e na proservaçäo desses pacientes

Câncer bucal: estudo epidemiológico de 1286 casos de carcinoma espinocelular da mucosa bucal / Buccal cancer: epidemiological study of 1286 cases of the spinocellular carcinoma of the bucal mucosa

No presente trabalho, avaliamos a análise do levantamento epidemiológico de 1286 prontuários de pacientes com diagnóstico de carcinoma espinocelular (CEC) da mucosa bucal atendidos no Instituto do Câncer "Arnaldo Vieira de Carvalho", no período de 06-76 a 07-96 (20 anos). Após este estudo, o autor distribuiu os prontuários por época de diagnóstico em dois períodos, o primeiro de 06-76 a 06-86 e o segundo de 07-86 a 07-96 e executou análise comparativa dos resultados epidemiológicos obtidos entre os dois períodos analisados. Houveram modificaçöes significativas nos dados epidemiológicos em relaçäo ao paciente com CEC de boca, como altraçöes em relaçäo a faixa etária, sexo, no vício do tabagismo e etilismo no sexo feminino, na localizaçäo da lesäo primária, no tratamento proposto para esta neoplasia. No estudo, conclui-se que as fichas clínicas, deveriam ser mais detalhadas pelo profissional e haver maior concordância na terminologia utilizada, principalmente no centros especializados no atendimento de pacientes com câncer

Osteorradionecrose: avaliaçäo dos fatores de risco / Osteoradionecrosis: evaluation of risk factors

No tratamento do câncer de boca, quando há a indicaçäo de radioterapia, o paciente deve ser submetido a avaliaçäo estomatológica, tendo como finalidade a prevençäo de complicaçöes causadas por essa terapia, dentre as quais a osteorradionecrose. Assim, neste trabalho, analisamos 487 prontuários de pacientes submetidos a radioterapia de carcinoma espinocelular de boca. Desses pacientes, 26 desenvolveram osteorradionecrose. Os principais fatores de risco encontrados foram: quantidade superior a 6500 rads em todos os casos, exodontia no pré-radioterápico (11 casos), no pós-radioterápico (8 casos), doença periodontal (4 casos), prótese mal adaptada (1 caso) e sem causas definidas (2 casos)

Mieloma múltiplo: caso clínico / Multiple myeloma: clinical case

Este trabalho tem como objetivo relatar um caso clínico de mieloma múltiplo, avaliando as características clínicas, histólogicas, radiográficas, tratamentos e prognóstico desta lesäo

Nomenclatura das lesões fundamentais / Nomenclature of the fundamental lesions

Os autores procuram conceituar e aclarar o significado semiológico das principais lesões fundamentais da Estomatologia e propõe uma uniformização no uso destes conceitos visando facilitar a comunicação inter-profissional e didática