Intraosseous rhabdomyosarcoma of the maxilla with TFCP2 fusion: A rare aggressive subtype with predilection for the gnathic bones.

Rhabdomyosarcomas (RMS) are malignant tumors with skeletal muscle differentiation extremely rare in intraosseous sites. We reported a rare case of an aggressive intraosseous RMS found in the maxilla of a 17-year-old female patient with five months of evolution. Computed tomography revealed a large osteolytic lesion extending from tooth 21 to 27, causing buccal and lingual cortical plate perforation. Microscopically, the lesion showed a proliferation of spindle-shaped cells with elongated nuclei and eosinophilic cytoplasm, arranged in an interlaced fascicle pattern. The nuclei ranged from vesicular with distinct nucleoli to hyperchromatic. A focal component of plump to epithelioid cells with a moderate amount of eosinophilic cytoplasm was seen at the periphery of the tumor. The immunohistochemical analysis revealed positivity for desmin, MyoD1, and myogenin (scattered cells). S-100, SOX10, HMB45, ß-catenin, and CD34 were negative. Ki-67 was positive in 30% of tumor cells. Fluorescence in situ hybridization (FISH) analysis showed the presence of a FUS-TFCP2 fusion. The diagnosis was intraosseous RMS with TFCP2 fusion. Surgical excision followed by chemo- and radiotherapy was carried out; however, the patient died of disease nine months after the treatment. Because of the rarity and non-specific signs and symptoms, the clinical diagnosis of intraosseous RMS is difficult and often overlooked. Therefore, careful histopathological evaluation, supported by immunohistochemical and molecular analysis, is essential to correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up are strongly recommended.

Clinical investigation of gustatory and neurosensory alterations following mandibular third molar surgery: an observational prospective study.

OBJECTIVE: This study aimed to prospectively observe gustatory and neurosensory alterations following surgical removal of mandibular third molars. MATERIAL AND METHODS: A prospective clinical study was conducted with patients who required mandibular third molar extraction, recruited from the Division of Oral and Maxillofacial Surgery at the Federal University of Ceará (Brazil). Age, sex, and radiographic signs were recorded. The outcome variables were the presence or absence of gustatory and neurosensory alterations. The patients were observed preoperatively and at 7, 30, 90, and 180 days postoperatively by using gustatory and neurosensory tests. RESULTS: The response to sweet (p = 0.509) and sour (p = 0.078) stimulus did not alter significantly over time. The salty threshold significantly increased from the preoperative to 7- and 30-day postoperative periods, returning to baseline values at 90 days postoperatively (p = 0.038). The bitter threshold increased significantly from the preoperative to 7-day postoperative period, returning to baseline values at 30 days after surgery (p < 0.001). Regarding neurosensory evaluation, there was an altered response to stimulus at 7 days postoperatively in specific studied areas, returning to baseline values 30 days after surgery (p < 0.05). CONCLUSION: The present study shows that mandibular third molar removal was associated with slight sensory disturbances related to mechanical, tactile, and gustatory perception. Regarding the recovery period, all patients returned to normal function without intervention, over a period ranging from 30 to 90 days. CLINICAL RELEVANCE: This study highlighted the importance of a sensory evaluation following removal of third molars, notably regarding mechanical perception and gustatory threshold assessment.

Atividade antimicrobiana da fibrina rica em plaquetas frente a cepas bacterianas orais / Antimicrobial activity of platelet-rich fibrin against oral bacteria

Objetivo: avaliar a atividade antimicrobiana da fibrina rica em plaquetas (PRF) frente a bactérias da cavidade oral. Material e métodos: foram coletadas amostras sanguíneas de seis pacientes que fizeram uso de PRF para fins de tratamento odontológico. Após a coleta, o sangue foi centrifugado seguindo duas metodologias distintas, uma a 1.800 rpm durante dez minutos e outra a 3.000 rpm durante dez minutos. A PRF obtida pelo processo foi separada e imediatamente utilizada para análise de sua atividade antimicrobiana. As cepas Streptococccus mutans, Streptococcus oralis, Streptococcus salivarius, Streptococcus parasanguinis, Streptococcus mitis, Lactobacillus acidophilus e Lactobacillus rhamnosus foram cultivadas em meio Brain Heart Infusion (BHI) suplementado com 1% de sacarose, sob atmosfera de microaerofilia a 37oC durante 48 horas. O potencial bactericida da PRF foi verificado através do teste de resistência ou sensibilidade bacteriana por difusão em ágar. Resultados: após a obtenção dos resultados, pôde-se observar que algumas bactérias, como a S. mutans, S. oralis, S. sanguise e S. parasanguinis, foram suscetíveis à PRF, segundo medição do halo de inibição. Ainda, houve diferenças quanto à atividade da PRF dentre as duas metodologias empregadas. Conclusão: a PRF possui atividade antimicrobiana considerável frente a determinadas espécies bacterianas orais, fato este que a torna um excelente produto para uso em Odontologia. Contudo, outros estudos devem ser realizados visando o mecanismo de ação antimicrobiana deste recurso. (AU)

Objective: to evaluate the antimicrobial activity of platelet-rich fibrin (PRF) against oral bacteria. Material and methods: blood samples were collected from 6 patients who used PRF for dental treatment. After collection, the blood was centrifuged following two different methodologies, one at 1,800 rpm for 10 minutes and the other at 3,000 rpm for 10 minutes. The PRF obtained by the process was separated and immediately used to analyze its antimicrobial activity. Streptococcus mutans, Streptococcus oralis, Streptococcus salivarius, Streptococcus parasanguinis, Streptococcus sanguis, Lactobacillus acidophilus and Lactobacillus rhamnosus were cultured in Brain Heart Infusion (BHI) supplemented with 1% sucrose under a microaerophilic atmosphere at 37oC for 48 hours. The bactericidal potential of the PRF was verified through the bacterial resistance test by diffusion in agar. Results: after obtaining the results, it was observed that some bacteria such as S. mutans, S. oralis, S. sanguis and S. parasanguinis were susceptible to PRF according to the measurement of the inhibition halo. It was also observed that there were differences in PRF activity among the two methodologies used. Conclusion: it was possible to perceive that PRF has considerable antimicrobial activity against certain oral bacterial species, a fact that makes it an excellent product for use in dentistry. However, other studies still needed to be performed aiming at the mechanisms of antimicrobial action of this resource. (AU)

Evidências científicas do uso da fibrina rica em plaquetas em odontologia: Uma revisão integrativa / Scientific evidence on the use of platelet-rich fibrin: an integrative review

Objetivo: realizar uma revisão da literatura em bases de dados eletrônicos sobre as evidências da eficácia da fibrina rica em plaquetas. Material e métodos: a partir dos bancos de dados Medline, PubMed e ClinicalKey, de março a junho de 2016, foi realizada um revisão integrativa de trabalhos sistemáticos e longitudinais. Dois revisores independentes avaliaram os critérios de inclusão e exclusão dos artigos, sendo incluídos artigos publicados de 2011 a maio de 2016. Resultados: a busca eletrônica resultou em um total de 16 referências. Conclusão: os estudos, em sua maioria, relataram aceleração do processo de cicatrização do tecido mole e diminuição da severidade das sequelas pós-operatórias imediatas em Odontologia.

Objective: to review the literature in electronic databases about the evidence of platelet rich fibrin efficiency. Material and methods: Medline, PubMed and ClinicalKey databases were searched from March to June 2016 using a combination of specific search terms. Two independent reviewers assessed the criteria for inclusion and exclusion of articles. with selected articles from 2011 to May 2016. Results: the electronic search resulted in a total of 16 references. Conclusion: most of the studies reported an acceleration of soft tissue healing process and severity decrease of the immediate postoperative sequelae in Dentistry.

Factors associated to post-operative nausea and vomiting following oral and maxillofacial surgery: a prospective study.

AIM: This study aims to address and assess possible factors associated with nausea and vomiting (NV) following oral and maxillofacial surgery. MATERIAL AND METHODS: A prospective study was carried out in the period from December 2013 to January 2016 targeting all attended cases in that period. For statistical analysis, Pearson chi-square and Fisher tests were used to verify association and ANOVA and Student's t tests to test for significant difference, p was defined as ≤0.05. The sample group consisted of 207 patients with an average age of 33.56 years (±13.23), and 70.5% of subjects were male. RESULTS: Calculations based on the predictive model showed that a female patient with prior history of nausea and vomiting who used opioids and had intra-oral surgical access would have a 96% chance of experiencing a nausea and vomiting episode. Other factors like age, being overweight, anesthesia, surgery duration, and duration of hospital stay also contribute so that these aspects must be paid careful attention prior to surgery to ensure a suitably orientated treatment that will avoid disturbances caused by post-operative nausea and vomiting. CONCLUSION: The occurrence of post-operative nausea and vomiting after oral and maxillofacial surgery was found to be more higher incidence associated to female patients who used opioids, who had a prior history of NV, whose surgery involved intra-oral access, who were in the second or third decades of their lives, who have above average weight, and who have long anesthesia when undergoing surgery, resulting in a long hospital stays.

Queiloplastia primária unilateral através da técnica de Fisher / Unilateral primary lip repair by Fisher technique

Introdução: As fissuras labiais são alterações congênitas que decorrem da não fusão dos processos nasais medianos com os processos nasais laterais, sendo sua ocorrência em aproximadamente 1:550 nascidos vivos. Essas fissuras podem apresentar-se bilaterais ou unilaterais nos lábios e acompanhadas ou não de fenda palatina. A cirurgia primária para reparação do lábio fissurado unilateral vem sendo descrita por diversas técnicas na literatura e geralmente envolve rotações de retalho e deixam cicatrizes visíveis bem como encurtamento do vermelhão do lábio. A técnica de Fisher foi proposta para resultar em uma cicatriz menos visível, em linha reta na região do filtro labial, colocando-a em uma região mais anatômica e simplificando a cirurgia. O objetivo deste artigo é mostrar um caso clínico de queiloplastia primária unilateral, utilizando a técnica de Fisher. Relado de Caso: Paciente CDSS, 8 meses de idade, portador de fissura lábio-palatina unilateral do lado esquerdo. A cirurgia do lábio foi realizada em ambiente hospitalar sob anestesia geral e a técnica utilizada foi a de Fisher. No acompanhamento de 30 dias o paciente apresentou-se com uma cicatriz bastante discreta, posicionada simetricamente em relação ao filtro labial do lado oposto. Conclusão: A técnica de Fisher mostrase como ótima opção para o tratamento de fissuras labiais unilaterais, pois proporciona uma excelente estética, a técnica cirúrgica é relativamente simples e acompanhada de bons resultados funcionais

Introduction: Cleft lip is a congenital abnormality arising from no merger of the median nasal processes with the lateral nasal processes, and their occurrence is approximately 1 in 550 live births. These clefts may present bilateral or unilateral lips and with or without cleft palate. The primary surgery for repair of unilateral cleft lip has been described by several techniques in literature and usually involves retail rotations and leave visible scars and lip vermilion shortening. Fisher technique has been proposed to result in a less visible scar, straight in the philtrum region placing it in a more anatomical region and simplifying the surgery. The purpose of this article is to show a case of unilateral primary lip repair using the Fisher technique. Case Report: Patient CDSS 8 months old has an unilateral cleft lip and palate on the left side. The lip surgery was performed in a hospital under general anesthesia and the technique used was Fisher. In the following 30 days, the patient is presented with a very slight scar, positioned symmetrically in relation to the philtrum of the opposite side. Conclusion: Fisher technique is shown as great option for the treatment of unilateral cleft lip, it provides an excellent aesthetic, the surgery technique is relatively simple and accompanied by good functional results

Extensive Melanotic Neuroectodermal Tumor of Infancy.

The melanotic neuroectodermal tumor of infancy (MNTI) is a rare childhood neoplasm with an alarming but classical clinical presentation. We present the case of a 2-month-old male infant treated with surgery for an aggressive MNTI on the alveolar process of the maxilla. Radiographic examination showed a diffuse osteolytic radiolucent lesion in the right maxilla, and displacement and dysmorphic changes in the developing primary tooth buds. The patient remained well without evidence of recurrence for 6 months after surgery. We discussed clinicopathological features, management alternatives, and outcome.

Avaliação do efeito da analgesia preemptiva sobre os eventos inflamatórios e níveis de citocinas pró-inflamatórias (TNF-α E IL-1β) em cirurgias de terceiros Molares inferiores

A cirurgia para remoção de terceiros molares constitui-se um procedimento frequentemente realizado em odontologia, estando associado a variados graus de dor pós-operatória, podendo afetar a qualidade de vida dos pacientes. Considerando o benefício máximo ao paciente submetido a uma cirurgia, insere-se a analgesia preemptiva como estratégia farmacológica amplamente pesquisada nas últimas décadas. O objetivo do presente estudo foi avaliar o efeito da analgesia preemptiva sob os efeitos inflamatórios e sob os níveis de citocinas pró-inflamatórias (TNF-α e IL-1β) em cirurgias de terceiros molares inferiores. Foi realizado um estudo unicêntrico, triplo-cego, randomizado, placebo-controlado, com 36 pacientes submetidos à remoção cirúrgica de terceiros molares mandibulares (n=72) que foram randomicamente alocados para receber etoricoxibe 120 mg, ibuprofeno 400mg ou placebo 1hora pré-operatoriamente, e os eventos inflamatórios (dor, edema e abertura bucal) foram avaliados. Houve diferença significativa entre os grupos com relação aos escores de dor(p<0,001)...

The surgery for removal of third molars constitutes a commonly performed procedure in dentistry, and is associated with varying degrees of postoperative pain, which can significantly affect the quality of life of patients. Considering the maximum benefit to the patient undergoing an operation, the preemptive analgesia has been the pharmacological strategy widely researched in recent decades. This study aimed to evaluate the pre-emptive analgesia effect on the levels of proinflammatory cytokines(TNF-αe IL-1β)following mandibular third molar surgery. A unicentric, triple-blind, randomized, placebo-controlled study was conducted with 36 patients undergoing surgical removal of mandibular third molars. All volunteers were allocated randomly to receive either etoricoxib 120 mg, ibuprofen 400 mg or placebo 1 hour preoperatively, and inflammatory events were evaluated. There was significant difference between groups with respect to pain scores (p <0.001)...

Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials.

The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.

Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease.

Renal osteodystrophy (ROD) is the bone pathology that occurs as an uncommon complication related to the several alterations in mineral metabolism present in patients with chronic kidney disease (CKD). This paper describes two cases of severe ROD affecting the maxilla and mandible and causing facial disfigurement of a young and a middle-aged female patient with CKD. Both patients had a history of secondary hyperparathyroidism, previously treated by surgery. The pathogenesis of the disease, as well as its clinical, imaging, and histopathological features, and management of the patient are discussed.

Large solitary fibrous tumor of the oral cavity--report of a case.

The solitary fibrous tumor (SFT) is a rare soft tissue tumor with a substantially benign clinical behavior. The SFT of the oral cavity is a very uncommon entity. It is also of complicated diagnosis because of its extensive morphologic diversity and because of its similarity to many mesenchymal tumors. A 44-year-old man was referred for management of an asymptomatic lesion in the left buccal mucosa, which had been identified 10 years earlier. Intra-oral examination revealed a well-demarcated, fibroelastic, rounded exophytic mass located in the left buccal mucosa. The mass was covered with a non-ulcerated mucosa of normal color and measured approximately 4.0 cm in diameter. Histopathological examination showed proliferation of spindle-shaped cells arranged in fascicles and in a patternless pattern, highly vascularized, with focal staghorn vessels. Immunohistochemical analysis revealed diffuse positivity for CD34 and focal positivity for Bcl-2. Awareness of the morphological diversity of SFT coupled to a judicious use of appropriate immunohistochemical probes should prove valuable to accurately segregate SFT from other spindle cell neoplasms.