CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: Importance to sagittal split osteotomy

Background: Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. Material and Methods: Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). Results: The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p < 0.05). The diameter of the MC was bigger among males in regions B and C. Conclusions: Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO (AU)

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Study of Genial Tubercles of Craniofacial Anomalies Individuals on Cone Beam Computed Tomography Scans.

PURPOSE: Genial tubercles (GTs) are bony protuberances on the lingual aspect of the mandible symphysis, where genioglossus and geniohyoid muscles are inserted. In the literature, few papers report their real dimensions. Cleft lip and palate are craniofacial anomalies involving the maxilla, but the anatomical structures of the mandible can be altered when these have associated with the cleft, some syndrome. This study aimed to evaluate the GTs of 30 individuals and to make their measurements in cone beam computed tomography examinations. METHODS: A sample of 30 individuals, 19 of them with cleft lip and palate, 6 individuals with Treacher Collins syndrome (TCS), and 5 individuals with Pierre Robin sequence, was used. The GTs were evaluated about the amount and the following measurements were performed: A--distance from the apex of the central incisors to GT, B--mandibular thickness in the region of GT, C-GT height, D-GT width, and E--distance from inferior border of mandible to GT. RESULTS: The individuals presented since the absence of GTs to 3. The TCS group had the highest average of the measurements A, D, and E with statistical difference (P = 0.006) (P = 0.011) and (P = 0.017), respectively. The Pierre Robin sequence group had the highest average measurement of B and C, but there was no statistical difference. CONCLUSIONS: The difference in the measurements can be explained perhaps because individuals with TCS have glossoptosis and changes on retrognathic mandible, which would affect the position of the GT.

Accessory mental foramina: prevalence, position and diameter assessed by cone-beam computed tomography and digital panoramic radiographs.

OBJECTIVE: To investigate the presentation of accessory mental foramina (AMF) on cone-beam computed tomography (CBCT) and digital panoramic examinations (PAN). STUDY DESIGN: Imaging examinations (i.e., CBCT and PAN) of 100 patients (200 hemi-mandibles) were assessed. AMF prevalence, diameter, and location related to adjacent teeth and to the mental foramen (MF) were analyzed. RESULTS: On CBCT images, the AMF was observed in 3% of the patients: two unilateral cases and one bilateral case, with mean diameter of 0.93 mm (±0.3); no AMF was identified on PAN. Most AMF were located between the premolars, either superiorly (two cases) or mesially (two cases) to the MF. The mean horizontal distance to the corresponding MF was 2.3 mm (±1.0) and the mean vertical distance was 4.0 mm (±0.7). CONCLUSIONS: The results of this study suggest that CBCT is an effective tool for presurgical tridimensional assessment of the neurovascular structures, such as MF and its variations; On the other hand, PAN examinations were not able to show the AMF cases assessed on CBCT.

Panorâmica versus TCFC para interpretação de ateromas calcificados da carótida / Panoramic versus CBCT exams to suggest carotid artery calcifications

Objetivo: o objetivo deste estudo foi avaliar a prevalência das calcificações na artéria carótida – CACs – em imagens digitais panorâmicas (PD) e de tomografia computadorizada de feixe cônico (TCFC) dos mesmos pacientes. A CAC é uma doença vascular que acomete os pacientes acima dos 50 anos, coincidindo com uma grande maioria de pacientes que procura reabilitação por implantes. Assim sendo, é importante que o implantodontista esteja atento à interpretação da CAC, uma vez que detectada requer encaminhamento do paciente a um cardiologista para confirmação do diagnóstico. Material e métodos: foram avaliadas 100 imagens (200 lados) de panorâmicas digitais (idade média de 48 anos) e a imagem TCFC dos mesmos pacientes. O re-exame das imagens panorâmicas foi realizado com o objetivo de identificar os CACs falso-positivos e falso-negativos em relação à TCFC. Resultados: considerando 200 lados analisadas, 3,5% (n=7/200) foram interpretadas como CACs em radiografias panorâmicas, e 2,5% (n=5/200) em imagens de TCFC. Dos sete casos CACs positivos em radiografias panorâmicas, três foram falso-positivos quando comparados à correspondente TCFC. Quanto aos cinco casos CACs positivos em TCFC, um era falso-negativo, comparado à imagem panorâmica respectiva. Conclusão: calcificações artéria carótida – CACs – podem ser vistas nas imagens panorâmicas e/ou TCFC, no entanto, a panorâmica tendeu a mostrar casos falso-positivos da CAC. A CAC surge como um achado incidental nos exames de panorâmica e de TCFC, mas ainda assim o dentista tem como obrigação encaminhar o paciente para um cardiologista para a confirmação do diagnóstico, uma vez detectada a sua suposta presença.

Uncommon trajectory variations of the mandibular canal and of the mandibular incisive canal: case report.

PURPOSE: This paper aims to report and discuss a case in which unusual anatomical variations were observed in the mandibular canal (MC) and the mandibular incisive canal (MIC) in a same patient. MATERIALS AND METHODS: A 49-year-old healthy female was referred for mandibular dental implant placement. Panoramic radiography and cone beam computed tomography (CBCT) were performed. Cross-sections, axial, coronal, panoramic reconstructions and volume rendering were obtained. RESULTS: The panoramic radiograph did not show any evidence of abnormality. CBCT showed a bifid MC on the right side. It extended to the buccal cortex, exteriorized for 6 mm and returned to its conventional trajectory to reach the mental foramen. On the left side, the MIC initially followed its normal trajectory for 4 mm but, in the canine region, it also extended to the buccal cortex and exteriorized. CONCLUSION: The advent of CBCT in Dentistry allowed a greater accuracy in the diagnosis of anatomical variations in the jaws, preventing injury to the neurovascular bundle and enabling an adequate surgical planning in the region.

Maxillary sinus and posterior teeth: accessing close relationship by cone-beam computed tomographic scanning in a Brazilian population.

INTRODUCTION: This study aimed to evaluate the close proximity established between the maxillary sinus floor and posterior teeth roots apices by using cone-beam computed tomographic scanning. METHODS: The relationship of maxillary sinuses and posterior teeth roots, which were divided into 2 groups, was analyzed using i-CAT Vision software (Imaging Sciences, Hatfield, PA). Group 1 included all root apices found in close contact with the maxillary sinus floor without sinus floor elevation, whereas group 2 included all root apices that were protruded within the sinus producing an elevation of the bony cortical. RESULTS: A total of 100 maxillary sinuses and 601 roots apices were evaluated. Group 1 presented 130 of 601 (21.6%) roots and group 2 presented 86 of 601 (14.3%) roots. CONCLUSIONS: The second molar mesiobuccal root apex is frequently found in close proximity with the sinus floor, and the relation between these anatomic structures should be considered in order to prevent an iatrogenic procedure and minimize the risks from an infectious disease within the sinus.

Variações anatômicas do canal mandibular detectadas em imagens de tomografia computadorizada de feixe cônico / Anatomic variations of mandibular canal detected in cone beam computed tomography images

O canal mandibular é uma estrutura anatômica de extrema importância na Implantodontia. Presenças de variações anatômicas no trajeto do canal podem determinar modificação no planejamento cirúrgico. O exame de tomografia computadorizada de feixe cônico (TCFC) permite a avaliação tridimensional da região de interesse, sendo uma técnica superior aos exames bidimensionais na detecção de variações anatômicas. O objetivo deste artigo foi apresentar as principais variações anatômicas do canal mandibular, que podem ser detectadas em exames de TCFC, e suas implicações clínicas. Foram utilizados 60 exames de TCFC pertencentes ao banco de imagens do Departamento de Estomatologia da Faculdade de Odontologia de Bauru. Os exames tinham o protocolo de escaneamento com campo de visão (FOV) de 6 cm, 8 cm ou 13 cm, e tamanho de voxel de 0,3 mm, tendo sido avaliados no software i-CAT Vision. Os critérios considerados durante a análise foram: presença de deiscências nas corticais ósseas e de ramificações. Observou-se quatro deiscências linguais do lado direito e oito do lado esquerdo, seis ramificações do lado esquerdo e três do lado direito. Ou seja, a presença de deiscências e ramificações no canal mandibular pode ser observada em aproximadamente 10% dos casos, em média, com uso de TCFC. As variações anatômicas no canal mandibular devem ser cuidadosamente avaliadas no volume total capturado pela TCFC, propiciando a realização de um adequado planejamento cirúrgico.

The mandibular canal is an anatomic structure of extreme importance in implantology. The presence of anatomical variations can determine changes in the surgical planning. The cone beam computed tomography (CBCT) exams enable three-dimensional evaluation of the interest region and it is a superior technique in comparison with two-dimensional images for the detection of anatomical variations. The aim of this paper is to present the main anatomical variations of the mandibular canal that can be detected in CBCT exams and its clinical implications. For this, 60 CBCT scans from the database of Department of Stomatology, Bauru Denta School, were used. The exams were obtained using 6 cm, 8 cm or 13 cm field of view (FOV) and 0.3 mm voxel size, evaluated with i-CAT Vision software. The criteria considered during the analysis were dehiscence of the cortical bone and ramifications. We observed four lingual dehiscences in the right side and eight in the left side, six ramifications in the left side and three in the right, which indicates that the ramifications and dehiscences of the mandibular canal can be observed in approximately 10% of cases, in average, using CBCT. The implantodontist should evaluate the entire CBCT image volume to search for anatomical variations in the mandibular canal for appropriate surgical planning.

Tomografia computadorizada de feixe cônico em implantodontia oral: Relato de série de casos / Cone-beam computed tomography in oral implantology: Case series report

A tomografia computadorizada de feixe cônico (TCFC) é uma ferramenta de diagnóstico por imagem com crescente utilização na Odontologia principalmente na implantodontia oral. Nessa especialidade, a sua utilização proporciona um melhor planejamento visto que medidas mais precisas de altura, largura, espessura e qualidade óssea podem ser obtidas. Além disso, as relações entre os potenciais sítios para instalação de implantes osseointegrados e estruturas anatõmicas nobres, especialmente seio maxilar, fossa nasal, forame mentual e canal mandibular, podem ser avaliadas com mais fidelidade. O objetivo deste trabalho foi apresentar uma série de casos onde a TCFC foi utilizada em pacientes submetidos à cirurgia de colocação de implantes osseointegrados. Em dois casos mostrou-se fundamental na determinação pré-operatória das dimensões dos implantes a serem instalados e escolha dos respectivos sítios anatômicos. Nos outros dois casos a TCFC apresentou-se relevante na resolução de complicações advindas da instalação de implantes que foram planejados com base apenas em exames convencionais (radiografias panorâmicas), situações em que houve deslocamentos acidentais para o interior do seio maxilar e do canal mandibular. Com base na série de casos relatados e na literatura consultada conclui-se que a TCFC é um exame de extrema importância na reabilitação oral através de implantes osseointegrados, desde o planejamento, prevenção de acidentes e resolução de eventuais complicações.

The cone beam computed tomography (CBCT) is a diagnostic imaging tool recently introduced in dentistry. In oral implantology its use provides a better planning as more precise measurements of height, width, thickness and bone quality can be obtained. In addition, the relationships among potential sites for implant placement and noble anatomic structures, especially the maxillary sinus, nasal cavity, the mental foramen and mandibular canal can be evaluated with more fidelity. The objective of this study was to present a series of cases in which the CBCT was used in patients submitted to implant placement surgery. In two cases the CBCT proved to be important in determining the preoperative dimensions of the implants and choose their anatomical sites. In the other two cases CBCT showed to be relevant to resolve the complications due to the implant installation that were planned based only in conventional exams (panoramic radioqraph), in these situations there were accidental implant displacement for inside the maxillary sinus and mandibular canal. Based on these report of a series of cases and in the literature used, it is concluded that CBCT is an exam extremely important in oral rehabilitation with implants, from planning, accident preventions and resolution of any complications.

Psammomatoid juvenile ossifying fibroma: an analysis of 2 cases affecting the mandible with review of the literature.

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous neoplasm, defined as a variant of the ossifying fibroma that arises within the craniofacial bones. Two subgroups, juvenile psammomatoid ossifying fibroma (PsJOF) and juvenile trabecular ossifying fibroma, have been delineated by their histology. PsJOF occurs predominantly in the sinonasal and orbital bones. This work reports on 2 cases of extensive PsJOF in the body of the right mandible as well as reviews the literature regarding the radiographic and histologic features, treatment, and prognosis of PsJOF of the jaws.

Avaliacão clínica e tratamento das complicações bucais pós quimioterapia e radioterapia / Clinical evaluation and treatment of oral complications after chemotherapy and radiotherapy

Este caso clínico se propõe a demonstrar a efetividade de opções terapêuticas para a o tratamento de complicações bucais decorrentes da quimioterapia e radioterapia. Paciente do gênero feminino, 48 anos de idade, leucoderma, com histórico de neoplasia de cabeça e pescoço com recidivas, apresentou complicações decorrentes da quimioterapia e radioterapia: mucosite oral, xerostomia, candidíase pseudomembranosa e herpes simples. As lesões foram tratadas respectivamente com laser de baixa intensidade, saliva artificial e lanolina médica, bochechas com nistatina e aciclovir sistêmico. Todos os tratamentos foram efetivos e bem tolerados pela paciente. O conhecimento do Cirurgião-Dentista, especialmente do Estomatologista quanto ao diagnóstico e tratamento das complicações bucais decorrentes da terapia antineoplásica foram fundamentais para a melhora na qualidade de vida da paciente.

This case report aims to demonstrate the effectiveness of therapeutic options for the treatment of oral complications after chemotherapy and radiotherapy. A female patient, a 48-year-old Caucasian with a history of head and neck neoplasms with recurrences, was referred to our clinic 1 month after the end of the radiotherapy sessions. She presented oral mucositis, hyposalivation, pseudomembranous candidiasis, and herpes simplex. The lesions were treated respectively with Low Levei Laser Therapy, artificial saliva, medicallanolin, nystatin oral suspension, and systemic acyclovir. These treatments were successful and sustained by the patient. The knowledge of dentists, especially stomatologists, in the diagnosis and treatment of complications arising from oral antineoplastic therapy were fundamental to improving the patient's quality of life.

Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients.

Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.

Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients

Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.

Estudo de calcificações em tecidos moles em exames de tomografia computadorizada de feixe cônico e radiografia panorâmica digital / Differentiating soft tissue calcifications in CBCT and panoramic images

A maioria das calcificações em tecidos moles na região de cabeça e pescoço são achados radiográficos incidentais. Com o crescente uso da Tomografia Computadorizada de Feixe Cônico na Odontologia (TCFC) há um aumento do número desses achados, visto que o exame permite a visualização das estruturas em três dimensões. Esse estudo estabeleceu uma metodologia para identificar algumas dessas calcificações. Um observador calibrado analisou 100 exames de TCFC e as respectivas panorâmicas, quanto à presença de Ossificação do Complexo Estilo-Hióideo (OCEH), tonsilólitos e ateromas. Adicionalmente os processos estilóides foram mensurados. As correlações para as radiografias panorâmicas foram estatisticamente significante entre idade e comprimento do processo estilóide. As correlações para os exames de TCFC foram estatisticamente significantes entre idade e tonsilólitos, idade e o comprimento do processo estilóide e idade e ateromas. Houve diferença estatística significante (Wilcoxon p<0,05) entre os exames de TCFC e panorâmicas quanto à presença de tonsilólitos, presença de OCEH e para as mensurações dos processos estilóides. Foi detectada maior quantidade de calcificações em tecidos moles nos exames de TCFC. A identificação das calcificações em tecidos moles é importante no diagnóstico diferencial de muitas patologias incluindo os flebólitos. Portanto o profissional deve ficar atento a correta interpretação dessas estruturas, buscando evitar erros e omissões, para que possa oferecer ao paciente opção correta de tratamento se for necessário.

The most common soft tissue calcifications in head and neck region are incidental findings in radiographic images. The use of Cone Beam Computed Tomography in Dentistry, has increased these incidental findings mainly, because CBCT allows a third dimension view. The goal of this study was to differentiate the styloid chain ossification (SHCO), tonsilloliths and calcified atheromas. Based on a specific methodology, one calibrated observer analysed 100 panoramic and CBCT exams from the same patients regarding these alterations. Afterwards, the styloid process was measured at the same exams. The correlations tests for the panoramic exams were statistically significant between age and styloid process length. The correlations tests for CBCT exams were statistically significant between age and tonsilloliths, age and styloid process length and age and calcified atheromas. There was a difference statistically significant (Wilcoxon p<0.05) between CBCT and panoramic exams regarding: presence of tonsillolith, presence of SHCO and styloid process length. It was detected more quantity of soft tissues calcifications in CBCT exams. The identification of soft tissues calcifications is important for the differential diagnoses of many pathologies including phlebolits. Therefore the professional should be able to do a correct image interpretation in some cases in order to avoid mistakes and offer the patient a treatment if is necessary.

Estudo de calcificações em tecidos moles em exames de tomografia computadorizada de feixe cônico e radiografia panorâmica digital / Differentiating soft tissue calcifications in CBCT and panoramic images

A maioria das calcificações em tecidos moles na região de cabeça e pescoço são achados radiográficos incidentais. Com o crescente uso da Tomografia Computadorizada de Feixe Cônico na Odontologia (TCFC) há um aumento do número desses achados, visto que o exame permite a visualização das estruturas em três dimensões. Esse estudo estabeleceu uma metodologia para identificar algumas dessas calcificações. Um observador calibrado analisou 100 exames de TCFC e as respectivas panorâmicas, quanto à presença de Ossificação do Complexo Estilo-Hióideo (OCEH), tonsilólitos e ateromas. Adicionalmente os processos estilóides foram mensurados. As correlações para as radiografias panorâmicas foram estatisticamente significante entre idade e comprimento do processo estilóide. As correlações para os exames de TCFC foram estatisticamente significantes entre idade e tonsilólitos, idade e o comprimento do processo estilóide e idade e ateromas. Houve diferença estatística significante (Wilcoxon p<0,05) entre os exames de TCFC e panorâmicas quanto à presença de tonsilólitos, presença de OCEH e para as mensurações dos processos estilóides. Foi detectada maior quantidade de calcificações em tecidos moles nos exames de TCFC. A identificação das calcificações em tecidos moles é importante no diagnóstico diferencial de muitas patologias incluindo os flebólitos. Portanto o profissional deve ficar atento a correta interpretação dessas estruturas, buscando evitar erros e omissões, para que possa oferecer ao paciente opção correta de tratamento se for necessário.

The most common soft tissue calcifications in head and neck region are incidental findings in radiographic images. The use of Cone Beam Computed Tomography in Dentistry, has increased these incidental findings mainly, because CBCT allows a third dimension view. The goal of this study was to differentiate the styloid chain ossification (SHCO), tonsilloliths and calcified atheromas. Based on a specific methodology, one calibrated observer analysed 100 panoramic and CBCT exams from the same patients regarding these alterations. Afterwards, the styloid process was measured at the same exams. The correlations tests for the panoramic exams were statistically significant between age and styloid process length. The correlations tests for CBCT exams were statistically significant between age and tonsilloliths, age and styloid process length and age and calcified atheromas. There was a difference statistically significant (Wilcoxon p<0.05) between CBCT and panoramic exams regarding: presence of tonsillolith, presence of SHCO and styloid process length. It was detected more quantity of soft tissues calcifications in CBCT exams. The identification of soft tissues calcifications is important for the differential diagnoses of many pathologies including phlebolits. Therefore the professional should be able to do a correct image interpretation in some cases in order to avoid mistakes and offer the patient a treatment if is necessary.

Management of a parotid sialocele in a young patient: case report and literature review.

Sialocele is a subcutaneous cavity containing saliva, caused by trauma or infection in the parotid gland parenchyma, laceration of the parotid duct or ductal stenosis with subsequent dilatation. It is characterized by an asymptomatic soft and mobile swelling on the parotid region. Imaging studies are useful and help establishing the diagnosis, such as sialography, ultrasonography, computed tomography and magnetic resonance imaging. This paper describes a recurrent case of a parotid sialocele in a young female patient. She presented a 6 cm x 5 cm swelling on the left parotid region. The ultrasonographic scan of the area revealed a hypoechoic ovoid well defined image suggesting a cyst. A sialography of the left parotid showed a cavitary sialectasia in a panoramic and anteroposterior view. A conservative management was adopted by percutaneous needle aspiration of the swelling, which was useful to provide material for analysis and helped healing. Dentists should be aware of this pathology and the importance in adopting a conservative treatment whenever it is possible.

Ameloblastic fibro-odontoma: a diagnostic challenge.

An 11-year-old girl presented to our department to have a second opinion regarding a lesion involving her left mandible. She had previously undergone several radiographic exams including panoramic, helical, and cone-beam computed tomography. Radiographic examinations revealed a well-defined radiolucent region, which contained an irregular radiopaque mass of 3 cm in diameter, localized to the left angle of the mandible. Our presumptive diagnosis was complex odontoma. Excisional biopsy was performed, and microscopic features showed strands and islands of odontogenic epithelium showing peripheral palisading and loosely arranged central cells, identical to stellate reticulum, embedded in a myxoid cell-rich stroma resembling the dental papilla. Dentin and enamel were also presented. The diagnosis was ameloblastic fibro-odontoma, which is a rare mixed odontogenic tumor, derived from epithelial and ectomesenchymal elements that form the dental tissues.

Von Recklinghausen's disease - diagnosis from oral lesion: neurofibromatosis I / Enfermedad de Von Recklinghausen: diagnóstico desde la lesión oral: neurofibromatosis I

A 35 years-old male patient was referred to your Institution due to a nodule on the palate with more than 15 years of evolution. In general physical examination noticed the presence of papules and café au lait (coffee with milk) pigmentation in many parts of the body. Intra oral examination found a swelling in the hard palate and resilient on palpation, asymptomatic with three centimeters of diameter. Incisional biopsy was performed and the diagnosis was neurofibroma. Complete resection of the lesion was performed confirming the initial diagnosis. The general clinical findings and the presence of neurofibroma confirmed the diagnosis of Von Recklinghausen's disease. This paper emphasizes the important role of the dentist in diagnostic and follow-up of the Von Recklinghausen's disease.

Un paciente hombre de 35 años de edad fue remitido a la Institución, debido a un nódulo en el paladar con más de 15 años de evolución. En el examen físico general, notaron la presencia de pápulas y pigmentaciones café au lait (café con leche) en muchas partes del cuerpo. Al examen oral intra se encontró un aumento de volúmen en el paladar duro resistente a la palpación, asintomático, con tres centímetros de diámetro. Se realizó la biopsia incisional, y el diagnóstico fue neurofibroma. La resección completa de la lesión confirma el diagnóstico inicial. Las conclusiones clínicas generales y la presencia de neurofibroma confirmó el diagnóstico de la enfermedad de Von Recklinghausen. Este trabajo destaca el importante papel del odontólogo en el diagnóstico y seguimiento de la enfermedad de Von Recklinghausen.

Management of a parotid sialocelein a young patient: case report and literature review

Sialocele is a subcutaneous cavity containing saliva, caused by trauma or infection in the parotid gland parenchyma, laceration of the parotid duct or ductal stenosis with subsequent dilatation. It is characterized by an asymptomatic soft and mobile swelling on the parotid region. Imaging studies are useful and help establishing the diagnosis, such as sialography, ultrasonography, computed tomography and magnetic resonance imaging. This paper describes a recurrent case of a parotid sialocele in a young female patient. She presented a 6 cm x 5 cm swelling on the left parotid region. The ultrasonographic scan of the area revealed a hypoechoic ovoid well defined image suggesting a cyst. A sialography of the left parotid showed a cavitary sialectasia in a panoramic and anteroposterior view. A conservative management was adopted by percutaneous needle aspiration of the swelling, which was useful to provide material for analysis and helped healing. Dentists should be aware of this pathology and the importance in adopting a conservative treatment whenever it is possible.

Fibroma de células gigantes: considerações gerais e relato de caso / Giant cell fibroma: general considerations and case report

O fibroma de células gigantes apresenta-se como um nódulo séssil ou pediculado, assintomático e geralmente menor que 1 cm de diâmetro. A maioria dos casos é diagnosticada em pessoas com idade entre 10 e 30 anos. A localização mais comum é na gengiva inferior, seguida da gengiva superior, língua e palato. O diagnóstico diferencial inclui papiloma, fibroma, granuloma piogênico e lesão periférica de células gigantes. Microscopicamente, o FCG é uma massa não encapsulada de tecido conjuntivo fibroso que contém numerosos fibroblastos, alguns destes multinucleados. Essas células são facilmente observadas na periferia da lesão, enquanto as áreas centrais apresentam fibroblastos típicos. A superfície epitelial é frequentemente corrugada e atrófica. O tratamento é constituído de remoção cirúrgica conservadora, uma vez que a recorrência é rara. O objetivo deste trabalho é apresentar um caso de extenso fibroma de células gigantes em gengiva superior de um homem de 40 anos que foi diagnosticado após biópsia exisional e exame microscópico.

Giant cell fibroma appears as an asymptomatic sessile or pedunculated nodule that is smaller than 1 cm in diameter. Most cases are diagnosed in persons aged 10-30 years. The most common sites are the mandibular gingiva, followed by the maxillary gingiva, the tongue, and the palate. The clinical differential diagnosis includes squamous papilloma, irritation fibroma, pyogenic granuloma, and peripheral giant cell granuloma. Microscopically, a giant cell fibroma is an unencapsulated mass of fibrous connective tissue that contains numerous characteristic large, plump, spindle-shaped and stellate fibroblasts, some of which are multinucleated. These cells are easily observed in the peripheral areas of the lesion, while the more central areas contain typical fusiform fibroblasts. The surface epithelium is often corrugated and atrophic. Conservative excisional biopsy is curative, and its findings are diagnostic. Recurrence is rare. The aim of this work is to present a case of a big giant cell fibroma in the upper gingival in a 40-years-old man, whose was diagnosed after excisional biopsy and microscopic exam.