Reclassification and treatment of odontogenic keratocysts: A cohort study.

The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Reclassification and treatment of odontogenic keratocysts: A cohort study

Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Intramuscular lipoma in the temporal region: a case report / Lipoma intramuscular em região temporal: relato de caso clínico

Few reports of intramuscular lipoma in the temporal region are seen in the literature. Because of its invasives characteristics, this neoplasm may be mistaken as a liposarcoma. Although image exams help in the differential diagnosis between benign and malignant lipomatous lesions, the histopathological exam is the only one capable of a definitive diagnosis. Total removal of the lesion is essential because the recurrence rate without complete excision may be as high as 62.5 %. A patient with an intramuscular lipoma located in the temporal region is presented along with the mentioned treatment. Great importance should be given to these uncommon lesions that may present as a challenge to professionals that work in the maxillofacial region.

Poucos relatos de lipoma intramuscular na região temporal são vistos na literature. Devido as suas características invasivas, essa neoplasia pode ser confundida com um lipossarcoma. Apesar de exames de imagem ajudarem no diagnóstico diferencial entre lesões lipomatosas benignas ou malignas, o exame histopatológico é o único capaz de diagnóstico definitivo. Remoção total da lesão é essencial pois a taxa de recidiva sem completa excisão pode ser de até 62,5%. Uma paciente com um lipoma intramuscular localizado na região temporal é apresentada com o devido tratamento da lesão. Grande importância deve ser dada a essas lesões incomuns que podem se apresentar como um desafio aos profissionais que atuam na região maxilofacial.

Late treatment of a mandibular gunshot wound.

Mandibular gunshot injuries are esthetically and functionally devastating, causing comminuted fractures and adjacent tissue destruction depending on the weapon gauge, projectile shape, impact kinetic energy, and density of the injured structures. If the mandibular fracture is not adequate or promptly treated, the broken fragments will fail to heal. In case of a treatment delay, progressive bone loss and fracture contracture will require a customized approach, which includes open reduction, removal of fibrous tissue between the bony stumps, and fixation of the fracture with a reconstruction plate and autogenous graft. The authors report the case of a 34-year-old man wounded on the mandible 15 years ago. With the aid of computed tomography and a prototype, a surgical plan was designed including open reduction and internal fixation of the segmental mandibular defect with a reconstruction plate and bone graft harvested from the iliac crest. The postoperative follow-up was uneventful and the 12-month follow up showed a positive aesthetic and functional result.

Importância dos tratamentos complementares na terapêutica cirúrgica do tumor odontogênico queratocísitico / Importance of complementary treatment for the surgical therapy of the keratocystic odontogenic tumor

Tratamentos complementares como excisão tegumentar; ostectomia periférica e aplicação da solução de Carnoy minimizam a recorrência do tumor odontogênico queratocístico após a ecérese conservadora por enucleação ou curetagem, embora sejam desconsiderados por alguns cirurgiões. O artigo revisa as técncias citadas e relata a combinação delas em dois casos dessa neoplasia odontogência, mostrando resultado efetivo em acompanhamento mínimo de cinco anos.

Nodular lymphocyte predominance Hodgkin lymphoma of the parotid gland: a case report.

The parotid is the most frequent site of primary salivary gland tumors. Lymphomas represent 0.2 to 0.8% of all malignant parotid tumors. Primary Hodgkin lymphoma of the parotid gland is rare with few cases reported in literature. The nodular lymphocyte predominance Hodgkin lymphoma (HL) is considered a particular clinical and histopathological subtype of HL. It has never been reported in the parotid gland since its incorporation in the 2001 World Health Organization Classification. The authors describe a case of a 32-year-old male who sought medical attention because of a one-year history of right cheek enlargement. A parotid nodule was submitted to a fine needle aspiration biopsy which disclosed a suspected lymphoproliferative disorder. A surgical dissection of the parotid gland was performed and an enlarged intraparotid lymph node measuring 4cm in its longest axis was excised, preserving the parotid gland integrity as well as the facial nerve. The pathological examination disclosed the diagnosis of nodular lymphocyte predominance Hodgkin lymphoma in this lymph node within the parotid gland. The treatment was completed with local radiotherapy and the 5-year follow up was uneventful.

Bilateral lingual lipoma: a case report.

Lipoma of the tongue is an uncommon benign tumor, being even more rare when there are multiple lesions. Lipoma accounts for 1-5% of all oral neoplasms. Lipoma occurs predominantly in males over the age of forty, although, in rare cases, children can be affected. Here, we report an unusual case of a female patient with bilateral lingual lipomas that were treated through surgical excision.

Intra-oral surgical access for the treatment of bilateral submandibular sialolithiasis: case report.

Sialolithiasis is a disease that affects the salivary glands. It is characterized by the presence of calcified structures within the duct system or within the glandular parenchyma. Those calculi, or sialoliths, can obstruct normal salivary flow, potentially leading to infectious sialadenitis, with pain, local swelling, and purulent discharge. Treatment typically consists of the surgical removal of the calculus, often in conjunction with sialoadenectomy. The authors report an atypical case of bilateral submandibular gland sialolithiasis treated conservatively, using intra-oral access to remove the calculi.

Tumor marrom bilateral do hiperparatiroidismo primário em mandíbula: relato de caso / Bilateral brown tumor of primary hyperparathyroidism in the mandible: case report

OBJETIVOS: Apresentar um caso de envolvimento mandibular bilateral por tumor marrom do hiperparatireoidismo primário e discutir a diferenciação do tumor marrom do hiperparatireoidismo com a lesão central de células gigantes. DISCUSSÃO E CONCLUSÃO: A diferenciação é estabelecida pela confirmação do distúrbio endócrino, fator determinante no tratamento do tumor. O tratamento foi a resolução da endocrinopatia pela exérese de adenoma nas glândulas paratireoide.

OBJECTIVES: To presente a cased of bilateral mandibular involvement by a brown tumor of hyperparathyreoidism,in which the treatment consisted in resolution of the endocrinopathy by neoplasm exeresis from the parathyroid glands. DISCUSSION AND CONCLUSION: The correct differentiation of the hyperparathyroidism brown tumor from the central giant cell lesion is an essential factor to avoid diagnostic errors and unnecessary treatments.This differentiation is established by the confirmation of endocrinal disturbance, a determinant factor in the treatment of the tumor.

Cavernous sinus thrombosis in a patient with facial myiasis.

Cavernous sinus thrombosis is a severe encephalic complication of the cervicofacial infections that can lead to death if not treated in adequate time. Among the several etiologies related to the development of this infection, myiasis has not been reported, enforcing the importance of the report of a case of thrombosis of the cavernous sinus developed from a facial myiasis.

Intubação Submento-Oro-Traqueal em Fraturas do Terço Médio Facial / Submental Intubation in Midface Fracture

A intubação submento-oro-traqueal é útil para o acesso transoperatório das vias aéreas em pacientes com traumatismos faciais severos, sendo uma alternativa à traqueostomia, em alguns casos. Suas indicações incluem casos em que o bloqueio maxilomandibular é imperativo, mas a intubação nasotraqueal torna-se impossibilitada por razões relacionadas ao trauma ou por alterações nasais pré-existentes. Este artigo relata um caso de fratura complexa do terço médio da face com aplicação dessa técnica, discutindo seus critérios de indicação e seus princípios técnicos

Princípios da reconstrução mandibular com enxerto ósseo vascularizado / Mandibular reconstruction principles underlying vascularized bone graft

Embora enxertos ósseos convencionais resolvam grande parte das reconstruções mandibulares, a ausência deum leito receptor favorável à revascularização óssea, muitas vezes, limita sua aplicação. O advento de enxertosósseos vascularizados em retalhos microcirúrgicos elevou o índice de sucesso nessas reconstruções, permitindo o restabelecimento estético-funcional em casos de pobre prognóstico reconstrutivo. As vantagens desse tipo de enxerto incluem manutenção do volume ósseo transplantado, possibilidade de reconstrução de grandes defeitos teciduais em áreas irradiadas, possibilidade de reconstrução das partes moles com associaçãode ilhas cutâneas e possibilidade de osteotomias, para reproduzir o contorno mandibular. O presente trabalho revisa a literatura referente aos enxertos ósseos vascularizados, discorrendo sobre os princípios biológicos e cirúrgicos que fundamentam sua aplicação na reconstrução mandibular.

Although conventional bone grafts are the solution for most mandibular reconstructions, their application is oftenlimited by the lack of a recipient bed amenable to the revascularization of bone. The advent of vascularized bonegrafts in microsurgical flaps has raised the success rate in these reconstructions, allowing the aesthetic andfunctional recovery of patients with a poor reconstructive prognosis. The advantages of this type of graft include the maintenance of the amount of bone transplanted, the possibility of reconstructing large tissue defects inirradiated areas, the possibility of reconstructing soft tissue associated with cutaneous islands and the chances to reproduce the mandibular contour. The present study reviews the literature on vascularized bone grafts and discusses the biological and surgical principles that underlie its application in mandibular reconstruction.

Princípios de reconstrução mandibular com enxerto ósseo vascularizado / Mandibular Reconstruction Principles with Vascularized Bone Graft

Embora enxertos ósseos convencionais resolvam grande parte das reconstruções mandibulares, a ausência de um leito receptor favorável à revascularização óssea muitas vezes limita sua aplicação. O advento de enxertos ósseos vascularizados em retalhos microcirúrgicos elevou o índice de sucesso nessas reconstruções, permitindo restabelecimento estético-funcional em casos de pobre prognóstico reconstrutivo. As vantagens desse tipo de enxerto incluem manutenção do volume ósseo transplantado, possibilidade de reconstrução de grandes defeitos teciduais em áreas irradiadas, possibilidade de reconstrução das partes moles com associação de ilhas cutâneas e possibilidade de osteotomias para reproduzir o contorno mandibular. O presente trabalho revisa a literatura referente aos enxertos ósseos vascularizados, discorrendo sobre os princípios biológicos e cirúrgicos que fundamentam sua aplicação na reconstrução mandibular

Complicações da solução de Carnoy no tratamento de tumores odontogênicos / Complications of Carnoy solution in the treatment of odontogenic tumors

Objetivo: Avaliar as complicações relacionadas ao uso da solução de Carnoy no tratamento complementar da loja cirúrgica após a exérese de tumores odontogênicos, comparando-as com as complicações descritas na crioterapia. Métodos: O estudo compreendeu uma análise retrospectiva dos tumores odontogênicos que receberam tratamento complementar com solução de Carnoy, no período de fevereiro de 2003 a janeiro de 2006. Resultados: Doze pacientes com média de idade de 28 anos foram analisados no estudo. Como dois pacientes eram portadores da síndrome de Gorlin, um total de 18 lesões compôs a seguinte amostra: tumor odontogênico queratocístico (n=14), tumor odontogênico cístico calcificante (n=2), ameloblastoma unicístico (n=1) e ameloblastoma multicístico (n=1). As complicações, observadas em dois pacientes, foram deiscência de sutura (n=2) e infecção (n=1). Conclusão: A utilização da solução de Carnoy é segura, provocando complicações mais brandas e menos freqüentes que as relatadas na crioterapia. Sua aplicação criteriosa sobre o nervo alveolar inferior pode ser adotada para diminuir o risco de recidiva em lesões posteriores da mandíbula.

Pleomorphic multicentric adenoma in the submandibular gland.

Neoplasms of salivary glands represent a small group among the diseases involving the head and neck complex. In this group, the pleomorphic adenoma is the most frequent neoplasm, yet involves the submandibular gland in only 12.3% of cases. A patient presenting a swelling in the region of the submandibular gland was submitted to an incisional biopsy, where a fragment of the gland and one juxtaposed node were removed. Histologically they were defined as pleomorphic adenoma. Later, the patient was submitted to submandibulectomy and two other nodes were found close to the gland and removed. All specimens were histologically defined as pleomorphic adenoma. This multicentric finding is of great interest, perhaps explaining the recurrence rate of this neoplasm. The patient is in continuous follow-up and has not presented signs of recurrence.

Trombose do seio cavernoso: revisão da literatura e relato de caso / Cavernous sinus thrombosis: review of the literature and case report

A trombose séptica do seio cavernoso é uma complicação encefálica decorrente de infecções faciais ou cranianas como sinusites, otites, infecções odontogênicas, oftalmológicas, entre outras. Apesar de rara, apresenta grande importância devido ao alto percentual de óbitos e seqüelas. As infecções odontogênicas, embora não ocupem posição destacada entre os fatores etiológicos dessa doença, podem atuar como focos primários situando o cirurgião-dentista entre os profissionais capazes de elaborar não só o diagnóstico, como sua profilaxia e o correto encaminhamento para tratamento médico especializado. O diagnóstico clínico dessa condição é dificultado pela semelhança com algumas infecções da órbita como a celulite orbital. Esse trabalho revisa a literatura e procura atualizar conceitos que facilitam o diagnóstico, a profilaxia e o tratamento da trombose do seio cavernoso. O trabalho também relata um caso dessa grave doença, originada de uma acne na região do mento, cuja rápida evolução levou o paciente ao óbito em três dias de tratamento. Após essa revisão, podemos afirmar que o diagnóstico dessa condição é clínico, com confirmação em exames de imagem, e quanto mais precoce o tratamento, melhor a chance de sobrevida. Infere-se também a importância da profilaxia antibiótica em cirurgias orais e faciais, atribuindo a ela redução significativa dessa infecção nos últimos tempos.

Imaging modality correlations of an odontogenic keratocyst in the nevoid basal cell carcinoma syndrome: a family case report.

Multiple maxillary and mandibular cysts are principle features of nevoid basal cell carcinoma syndrome (NBCCS; Gorlin-Goltz syndrome). We present a family case report of NBCCS with odontogenic keratocyst where the findings on plain films, CT, clinical, and histopathologic examinations are compared and analyzed. The systemic manifestations included frontal bossing, odontogenic keratocyst, ectopic calcification in 1 patient, and bifid rib in 1 patient. CT examination displayed aspects of bone morphology not visible on the plain films. Odontogenic keratocyst diagnosis was confirmed by histopathological examination. The features identified by these combined clinical, imaging, and histologic findings are helpful in identifying an NBCCS patient, distinguishing keratocyst from others cysts or neoplasic lesions, and can therefore influence surgical management. NBCCS is a rare autosomal dominant cancer predisposition syndrome, which is important to recognize when a patient has multiple odontogenic keratocysts, because lifelong monitoring is essential for patient management.

Actinomicose facial: relato de um caso / Facial actinomycosis: case report

Actinomicose é um processo infeccioso bacteriano. Seu diagnóstico é difícil e demanda um alto nível de suposição. Relatamos um caso de actinomicose facial cujo exame histológico confirmou a hipótese diagnosticada