Solitary fibrous tumor: Two cases report with a focus on the differential diagnosis / Tumor Fibroso Solitário: Relato de dois casos com foco no diagnóstico diferencial

Solitary fibrous tumor (SFT) is a neoplasm of fibroblastic/myofibroblastic origin with intermediate biological behavior. We report here two cases of SFT affecting an unusual anatomical site in 58-year-old and 40-year-old female patients and discuss the differential diagnosis of this lesion. In case 01, the lesion showed the clinical appearance of an asymptomatic "blister" with normal color, rubbery consistency, measuring 0.3 cm, and affected the lower lip; while in case 02, a symptomatic red nodular lesion with a soft consistency and measuring 0.5 cm affected the floor of the mouth. Excisional biopsies were performed. Microscopically, two well-delimited benign neoplasms were observed, exhibiting the proliferation of ovoid to spindle-shaped mesenchymal cells, vascular spaces with staghorn arrangement, and the absence of mitosis figures. Immunohistochemistry was performed in case 01 to assist in the diagnosis. Weak and diffuse immunostaining was observed for α-SMA and intense and diffuse immunopositivity for Bcl-2 and CD34. Based on histopathological and immunohistochemical features, a diagnosis of SFT was rendered in both cases. The low occurrence and nonspecific clinical features of oral SFT may make its clinical diagnosis difficult. Also, morphological and immunohistochemical are essential for differential diagnosis with other mesenchymal neoplasms.(AU)

O tumor fibroso solitário (TFS) é uma neoplasia de origem fibroblástica/miofibroblastica com comportamento biológico intermediário. Nesse artigo relatamos dois casos de TFS afetando sítios anatômicos incomuns em pacientes do sexo feminino de 58 anos e 40 anos e discutir os seus diagnósticos. No caso 01 clinicamente a lesão apresentou um aspecto de "bolha" assintomática, coloração normal da mucosa, consistência borrachoide medindo 0,3 cm, em região de lábio inferior, enquanto que no caso 02, como uma lesão sintomática, vermelha, nodular com consistência mole e medindo 0,5 cm afetando o assoalho bucal. As biópsias excecionais foram realizadas. Microscopicamente, observamos duas lesões neoplásicas bem delimitadas exibindo uma proliferação de células mesenquimais variando de ovoides a fusiformes, vasos sanguíneos em formato de "chifre de veado", com ausência de figuras de mitoses. No caso 01 foi realizado análise imuno-histoquímica para auxiliar no diagnóstico. Foi observado uma marcação fraca e difusa de α-SMA e uma intensa e difusa imunopositividade para o Bcl-2 e CD34.Baseado nos achados histopatológicos e imuno-histoquímicos o diagnóstico de TFS foi estabelecido em ambos os casos. A baixa ocorrência e os achados clínicos inespecíficos do TFS oral podem dificultar o diagnóstico clínico. Além disso, as análises morfológicas e imuno-histoquimicas são essenciais para realização do diagnóstico diferencial com outras neoplasias mesenquimais.(AU)_

PANCREATECTOMY AND HEPATECTOMY: A COMBINED SURGICAL RESECTION OF PSEUDOPAPILLARY SOLID TUMOR OF PANCREAS ASSOCIATED WITH HEPATIC METASTASIS.

BACKGROUND: Solid pseudopapillary tumor of the pancreas has been frequently reported in the past two decades. Surgery remains the treatment of choice, with the liver being the most frequent site of metastases. AIMS: The study aimed to present an option of surgical treatment for an 18-year-old female patient with a solid lesion in the body and tail of the pancreas associated with metastatic lesions in both hepatic lobes. METHODS: Two surgical procedures were scheduled. In the first procedure, body-caudal pancreatectomy with splenectomy was performed, associated with the resection of three lesions of the liver's left lobe. A right hepatectomy was performed 6 months later, progressing without complications. RESULTS: The patient continues without clinical complaints on the last return, and abdominal magnetic resonance performed 28 months after the second procedure does not show liver or abdominal cavity lesions. CONCLUSIONS: The knowledge on the biological behavior of tumors, evolution, and recurrence risks allows the indication of more rational surgical techniques that best benefit patients.

SEROUS CYSTADENOMA OF PANCREAS: WHY THERE IS LOW ACCURACY IN IMAGING EXAMS? / CISTOADENOMA SEROSO DE PÂNCREAS. POR QUE A ACURÁCIA É BAIXA AOS EXAMES DE IMAGEM?

AIM: Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due to diagnostic doubt. The aim of this study was to analyze the causes of low accuracy in diagnosing SCP. METHODS: This is a retrospective study of patients with SCP from a database of two hepatopancreatic biliary surgery outpatient clinics between 2006 and 2020. Patients with typical SCP lesions in imaging exams (e.g., tomography, magnetic resonance imaging [MRI], and endoscopic ultrasound [EUS]) and patients whose pathological testing confirmed this diagnosis were included. RESULTS: A total of 27 patients were included in this study. Most patients were women (85.18%), and the mean age was 63.4 years. Only one patient had typical pancreatitis symptoms. MRI was the most performed method (62.9%). The lesion was single in 88.9%, and the average size was 4 cm. The typical microcystic aspect was found in 66.6%. EUS was performed in 29.6% of cases. The mean carcinoembryonic antigen value in patients undergoing cyst puncture was 198.25 ng/mL. Surgical treatment was performed in 10 cases (37%). The cause of surgery in seven of these cases was due to a suspicion of mucinous cystadenoma based on an identification of atypical lesions (unilocular with or without septa and macrocystic) in imaging exams. A suspicion of intraductal papillary mucinous neoplasm with "worrying factors" was the indication for surgery in two cases. The last case underwent surgical treatment for a solid-looking lesion which was suspected of cancer. The complication rate ≥Clavien-Dindo 2 was 30%, and the clinically relevant pancreatic fistula rate (B and C) was 30%. Mortality was nil. CONCLUSION: The atypical morphological presentation of SCP, particularly unilocular and macrocystic lesions, is the main indication for surgery. Only the implementation of new, efficient, and reproducible diagnostic methods can reduce the number of unnecessary surgeries among these patients.

OBJETIVO: Apesar da recomendação atual que o cistoadenoma seroso deva ser tratado de forma conservadora, significativa parte dos pacientes com essa condição ainda é operada por dúvida diagnóstica. Analisar causas da baixa acurácia diagnóstica do cistoadenoma seroso. MÉTODOS: Estudo retrospectivo de portadores de cistoadenoma seroso de um banco de dados de dois ambulatórios de cirurgia hepatopancreaticobiliar entre 2006 e 2020. Foram incluídos pacientes com lesões típicas de cistoadenoma seroso aos exames de imagem (tomografia computadorizada, ressonância magnética e ecoendoscopia) e pacientes que o anatomopatológico confirmasse esse diagnóstico. RESULTADOS: 27 pacientes foram incluídos. 85,18% eram do sexo feminino. A idade média foi de 63,4 anos. Apenas um apresentava sintomas típicos de pancreatite. A Ressonância magnética foi o exame mais realizado (62,9%). A lesão era única em 88,9% e o tamanho médio foi 4 cm. O aspecto típico microcístico foi encontrado em 66,6% dos casos, os demais foram considerados atípicos. A ecoendoscopia foi realizada em 29,6%. O valor médio de antígeno carcinoembrionário nos pacientes submetidos à punção do cisto foi de 198,25 ng/mL. O tratamento cirúrgico foi realizado em 10 casos (37%). Em 7, a causa cirúrgica foi a suspeita do cistoadenoma mucinoso mediante identificação de lesões atípicas (unilocular com ou sem septos e macrocística). Em 2, a suspeita de neoplasia papilar intraductal mucinosa com "fatores preocupantes" foi a indicação cirúrgica. O último foi submetido à cirurgia por lesão de aspecto sólido e suspeita de câncer. O índice de complicações > ou = Clavien-Dindo 2 foi 30%, o índice de fístula pancreática clinicamente relevante (B e C) foi 30%. A mortalidade foi nula. CONCLUSÃO: A apresentação morfológica atípica do cistoadenoma seroso, particularmente lesões uniloculares e macrocísticas, é a principal responsável pela indicação cirúrgica. Apenas a implementação de novos, eficientes e reprodutíveis métodos diagnósticos poderá reduzir o número de cirurgias desnecessárias nesses pacientes.

Pancreatectomy and hepatectomy: a combined surgical resection of pseudopapillary solid tumor of pancreas associated with hepatic metastasis / Pancreatectomy and hepatectomy: ressecção cirúrgica combinada de tumor pseudopapilar sólido do pâncreas com metástases hepáticas

ABSTRACT BACKGROUND: Solid pseudopapillary tumor of the pancreas has been frequently reported in the past two decades. Surgery remains the treatment of choice, with the liver being the most frequent site of metastases. AIMS: The study aimed to present an option of surgical treatment for an 18-year-old female patient with a solid lesion in the body and tail of the pancreas associated with metastatic lesions in both hepatic lobes. METHODS: Two surgical procedures were scheduled. In the first procedure, body-caudal pancreatectomy with splenectomy was performed, associated with the resection of three lesions of the liver's left lobe. A right hepatectomy was performed 6 months later, progressing without complications. RESULTS: The patient continues without clinical complaints on the last return, and abdominal magnetic resonance performed 28 months after the second procedure does not show liver or abdominal cavity lesions. CONCLUSIONS: The knowledge on the biological behavior of tumors, evolution, and recurrence risks allows the indication of more rational surgical techniques that best benefit patients.

RESUMO RACIONAL: O tumor sólido pseudopapilar do pâncreas tem sido relatado na literatura com mais frequência nas últimas duas décadas. A cirurgia continua sendo o tratamento indicado, sendo o fígado o local mais frequente de metástases. OBJETIVOS: Apresentar a opção de tratamento cirúrgico de paciente feminino, 18 anos, com lesão sólida no corpo e cauda do pâncreas associada a lesões metastáticas em ambos os lobos hepáticos. MÉTODOS: Dois procedimentos cirúrgicos foram agendados. No primeiro procedimento foi realizada pancreatectomia corpo-caudal com esplenectomia, associada à ressecção de 3 lesões do lobo esquerdo do fígado. A hepatectomia direita foi realizada seis meses após, evoluindo sem complicações. RESULTADOS: O paciente continua sem queixas clínicas no último retorno, e a ressonância magnética do abdomem realizada 28 meses após o segundo procedimento não mostra lesões hepáticas ou na cavidade abdominal. CONCLUSÕES: O conhecimento do comportamento biológico dos tumores, a evolução e os riscos de recidiva, permitem a indicação de técnicas cirúrgicas mais racionais e que melhor beneficiam os pacientes.

Early recovery after surgery protocol in orthognathic surgery: a randomized, blind clinical study.

A randomized, blind and prospective clinical trial was conducted to compare two clinical rehabilitation protocols in patients submitted to orthognathic surgery, during the first 60 days after surgery. Pain, edema, mandibular movement, masticatory efficiency and quality of life were evaluated. Nineteen (19) patients were separated into control and experimental groups. The control group consisted of 10 patients followed by oral and maxillofacial surgeons and submitted to a rehabilitation protocol that involved active and passive mouth opening exercises. The experimental group had 9 patients and followed the surgeons' protocol, in addition to an Early Recovery After Surgery (ERAS) protocol performed by speech therapists, and involving specific motricity exercises and lymphatic drainage. The Student's t-test was applied to compare the results, and the Fisher's exact test of independence, to analyze the quality of life and the masticatory efficiency variables. The statistical significance was set at 5% (p < 0.05) for all the tests. The results showed that the ERAS protocol made a positive difference in pain perception in the first 14 days. However, it did not improve the other variables. Although many variables showed no significant difference, it was concluded that the surgeons can delegate patient rehabilitation to qualified professionals, so that they can optimize their postoperative clinical time.

Cistoadenoma seroso de pâncreas. por que a acurácia é baixa aos exames de imagem? / Serous cystadenoma of pancreas: why there is low accuracy in imaging exams?

RESUMO - RACIONAL: Apesar da recomendação atual que o cistoadenoma seroso deva ser tratado de forma conservadora, significativa parte dos pacientes com essa condição ainda é operada por dúvida diagnóstica. OBJETIVO: Analisar causas da baixa acurácia diagnóstica do cistoadenoma seroso. MÉTODOS: Estudo retrospectivo de portadores de cistoadenoma seroso de um banco de dados de dois ambulatórios de cirurgia hepatopancreaticobiliar entre 2006 e 2020. Foram incluídos pacientes com lesões típicas de cistoadenoma seroso aos exames de imagem (tomografia computadorizada, ressonância magnética e ecoendoscopia) e pacientes que o anatomopatológico confirmasse esse diagnóstico. RESULTADOS: 27 pacientes foram incluídos. 85,18% eram do sexo feminino. A idade média foi de 63,4 anos. Apenas um apresentava sintomas típicos de pancreatite. A Ressonância magnética foi o exame mais realizado (62,9%). A lesão era única em 88,9% e o tamanho médio foi 4 cm. O aspecto típico microcístico foi encontrado em 66,6% dos casos, os demais foram considerados atípicos. A ecoendoscopia foi realizada em 29,6%. O valor médio de antígeno carcinoembrionário nos pacientes submetidos à punção do cisto foi de 198,25 ng/mL. O tratamento cirúrgico foi realizado em 10 casos (37%). Em 7, a causa cirúrgica foi a suspeita do cistoadenoma mucinoso mediante identificação de lesões atípicas (unilocular com ou sem septos e macrocística). Em 2, a suspeita de neoplasia papilar intraductal mucinosa com "fatores preocupantes" foi a indicação cirúrgica. O último foi submetido à cirurgia por lesão de aspecto sólido e suspeita de câncer. O índice de complicações > ou = Clavien-Dindo 2 foi 30%, o índice de fístula pancreática clinicamente relevante (B e C) foi 30%. A mortalidade foi nula. CONCLUSÃO: A apresentação morfológica atípica do cistoadenoma seroso, particularmente lesões uniloculares e macrocísticas, é a principal responsável pela indicação cirúrgica. Apenas a implementação de novos, eficientes e reprodutíveis métodos diagnósticos poderá reduzir o número de cirurgias desnecessárias nesses pacientes.

ABSTRACT - BACKGROUND: Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due to diagnostic doubt. AIM: The aim of this study was to analyze the causes of low accuracy in diagnosing SCP. METHODS: This is a retrospective study of patients with SCP from a database of two hepatopancreatic biliary surgery outpatient clinics between 2006 and 2020. Patients with typical SCP lesions in imaging exams (e.g., tomography, magnetic resonance imaging [MRI], and endoscopic ultrasound [EUS]) and patients whose pathological testing confirmed this diagnosis were included. RESULTS: A total of 27 patients were included in this study. Most patients were women (85.18%), and the mean age was 63.4 years. Only one patient had typical pancreatitis symptoms. MRI was the most performed method (62.9%). The lesion was single in 88.9%, and the average size was 4 cm. The typical microcystic aspect was found in 66.6%. EUS was performed in 29.6% of cases. The mean carcinoembryonic antigen value in patients undergoing cyst puncture was 198.25 ng/mL. Surgical treatment was performed in 10 cases (37%). The cause of surgery in seven of these cases was due to a suspicion of mucinous cystadenoma based on an identification of atypical lesions (unilocular with or without septa and macrocystic) in imaging exams. A suspicion of intraductal papillary mucinous neoplasm with "worrying factors" was the indication for surgery in two cases. The last case underwent surgical treatment for a solid-looking lesion which was suspected of cancer. The complication rate ≥Clavien-Dindo 2 was 30%, and the clinically relevant pancreatic fistula rate (B and C) was 30%. Mortality was nil. CONCLUSION: The atypical morphological presentation of SCP, particularly unilocular and macrocystic lesions, is the main indication for surgery. Only the implementation of new, efficient, and reproducible diagnostic methods can reduce the number of unnecessary surgeries among these patients.

Early recovery after surgery protocol in orthognathic surgery: a randomized, blind clinical study

Abstract A randomized, blind and prospective clinical trial was conducted to compare two clinical rehabilitation protocols in patients submitted to orthognathic surgery, during the first 60 days after surgery. Pain, edema, mandibular movement, masticatory efficiency and quality of life were evaluated. Nineteen (19) patients were separated into control and experimental groups. The control group consisted of 10 patients followed by oral and maxillofacial surgeons and submitted to a rehabilitation protocol that involved active and passive mouth opening exercises. The experimental group had 9 patients and followed the surgeons' protocol, in addition to an Early Recovery After Surgery (ERAS) protocol performed by speech therapists, and involving specific motricity exercises and lymphatic drainage. The Student's t-test was applied to compare the results, and the Fisher's exact test of independence, to analyze the quality of life and the masticatory efficiency variables. The statistical significance was set at 5% (p < 0.05) for all the tests. The results showed that the ERAS protocol made a positive difference in pain perception in the first 14 days. However, it did not improve the other variables. Although many variables showed no significant difference, it was concluded that the surgeons can delegate patient rehabilitation to qualified professionals, so that they can optimize their postoperative clinical time.

Expansão mandibular por distração osteogênica ­ relato de caso / Mandibular expansion by osteogenic distraction ­ case report

Introdução: As deficiências transversais mandibulares são comumente corrigidas com expansão ortodôntica dentoalveolar, vestibularizações dentárias, desgastes interproximais e/ou extração dentária. Nesse contexto, a distração osteogênica da sínfise mandibular (DOSM) tem sido proposta como uma boa opção de tratamento. Objetivo: Relatar o caso clínico de um paciente com mandíbula atrésica tratado com DOSM, enfatizando a etapa ortodôntica pré-cirúrgica e a cirurgia propriamente dita. Resultados: Essa modalidade de tratamento aumentou significativamente a largura mandibular, dispensando a necessidade de tratamento ortodôntico com extrações. Conclusão: A distração osteogênica mediana transversal de mandíbula é uma técnica cirúrgica efetiva para correção de deficiências mandibulares transversais severas, em que os resultados obtidos exclusivamente com Ortodontia são limitados. Essa técnica permite movimentos esqueléticos amplos com um mínimo de recidiva por expandir concomitante o osso e os tecidos moles. (AU)

Introduction: Mandibular transversal deficiencies are commonly corrected with dentoalveolar orthodontic expansion, dental vestibularizations, interproximal wear and/or tooth extraction. In this context, the osteogenic distraction of the mandibular symphysis (ODMS) has been proposed as a good treatment option. Objective: To report the clinical case of a patient with atresic mandible treated with ODMS emphasizing the pre-surgical orthodontic stage and the surgery itself. Results: This modality of treatment significantly increased the mandibular width, dispensing the need for orthodontic treatment with extractions. Conclusion: Mandible transverse medial osteogenic distraction is an effective surgical technique for correction of severe transverse mandibular deficiencies, in which results obtained exclusively with orthodontics are limited. This technique allows large skeletal movements with minimal recurrence by expanding concomitantly the bone and soft tissues.(AU)

Cephalometric analysis: concordance between software / Análise cefalométrica: concordância entre softwares

ABSTRACT Objective: To evaluate the agreement between cephalometric measures obtained from two different software programs: Dolphin Imaging 11.7® and Radiocef Studio 2® . Methods: 30 digital lateral teleradiographies (200 dpi, 2100 x 2092 pixels) were analyzed on each of the software programs through demarcation of 11 cephalometric points by a single calibrated examiner. Then, the generated cephalometric magnitudes were statistically correlated by means of the intraclass correlation coefficients (ICC). Then 10 randomly selected radiographies were retraced on each of the programs in order to evaluate the intra-examiner concordance after a time interval of 08 days. Results: The SNB and Pog-NB magnitudes showed strong concordance between the software, while the SNA, ANB, 1-NA, 1-NB, 1.NB, 1.1 and Go-Gn.SN magnitudes unveiled moderate concordance. Only the 1.NA magnitude showed weak concordance. Conclusion: The software can be interchangeably applied in clinical practice.

RESUMO Objetivo: Avaliar a concordância entre grandezas cefalométricas obtidas através dos softwares Dolphin Imaging 11.7® e Radiocef Studio 2® . Métodos: Trinta telerradiografias laterais digitais (200 dpi, 2100 x 2092 pixels) foram analisadas em cada um dos softwares através da demarcação de 11 pontos cefalométricos por um único examinador calibrado. As grandezas cefalométricas geradas foram correlacionadas estatisticamente por meio dos coeficientes de correlação intra classe (CCI). A fim de avaliar a concordância intra-examinador, 10 telerradiografias selecionadas aleatoriamente foram retraçadas em cada um dos softwares após um intervalo de 8 dias. Resultados: As grandezas SNB e Pog-NB mostraram forte concordância entre os softwares, enquanto que as grandezas SNA, ANB, 1-NA, 1-NB, 1.NB, 1.1 e Go-Gn.SN revelaram concordância moderada. Somente a grandeza 1.NA demonstrou fraca concordância. Conclusão: Os softwares podem ser aplicados intercambiavelmente na prática clínica.

Enxertos ósseos autógenos intrabucais em implantodontia: estudo retrospectivo / Intraoral autogenous bone grafts in implantology: a retrospective study

Após as extrações dentárias, o osso alveolar sofre um processo fisiológico de reabsorção que, muitas vezes, dificulta a instalação de implantes osseointegrados, porém procedimentos reconstrutivos visam viabilizar a instalação correta dos implantes. O objetivo deste estudo foi avaliar os enxertos ósseos autógenos removidos de áreas intrabucais e sua eficácia em relação à osseointegração na área enxertada. Tratou-se de um estudo observacional descritivo retrospectivo, baseado nos dados coletados nos prontuários. Dos sítios doadores avaliados, 54,17% eram do ramo da mandíbula e 43,75% da região mentoniana. Observou-se que, dos 98 implantes instalados, 97,96% obtiveram sucesso e ainda permaneciam em função. Com relação ao objetivo do enxerto, 56,25% foram destinados ao tipo Inlay, enquanto 43,75% foram do tipo Onlay. Complicações pós-operatórias foram observadas em 22,91% dos casos, sendo a parestesia a mais frequente, 95% dos pacientes relataram estar satisfeitos com a reabilitação sobre implantes e 97,50% se sujeitariam a um novo procedimento cirúrgico envolvendo reconstrução óssea se necessário. O estudo mostrou um elevado índice de sucesso dos implantes em áreas enxertadas, caracterizando essas reconstruções como um fator de baixo risco para osseointegração... (AU)

Alveolar bone undergoes a physiological resorption process after tooth extraction, creating difficulties for the insertion of dental implants, but reconstructive procedures enable the correct installation of implants. This study aims to evaluate autogenous bone grafts harvested from intraoral donor sites in order to assess their effectiveness in relation to implant osseointegration. This was a retrospective observational descriptive study based on data collected from medical records. The donor sites evaluated were the mandibular ramus (54.17%) and the chin region (43.75%). It was observed that of 98 implants inserted, 97.96% were successful and continued to function. Inlay grafts were used in 56.25% of cases and onlay ones in 43.75%. Postoperative complications were observed in 22.91% of cases, the most frequent of which was paresthesia. Ninety-five percent of patients reported they were satisfied with their rehabilitation over implants and 97.50% would be willing to undergo a similar surgical procedure involving bone reconstruction if necessary. The study showed a high success rate of implants in the graft areas, thereby characterizing such reconstructions as a low-risk factor for osseointegration... (AU)

Treatment of oral hemangioma with sclerotherapy: case report / Tratamento de hemangioma oral com escleroterapia: relato de caso

Hemangiomas are benign neoplasms that are common in the head and neck, but relatively rare in the oral cavity. They can cause esthetic and functional impairment, depending on location. The most common site is the upper lip, but they can occur in other areas, such as the tongue, buccal mucosa and palate. Treatment is primarily dependent on correct diagnosis of the lesion and on its anatomic location. The purpose of this article is to provide a description of a case of a hemangioma on the upper lip, treated by therapeutic sclerosis with monoethanolamine oleate (Ethamolin®), covering clinical characteristics and methods for diagnosing these lesions. Precise diagnosis and appropriate therapeutic management resulted in satisfactory esthetic and functional results, with total regression of the lesion and no signs of relapse at 1-year follow-up...

O hemangioma é uma neoplasia benigna comum na região de cabeça e pescoço, e é relativamente rara na cavidade oral, podendo causar prejuízo estético e funcional a depender da sua localização. Sua localização mais frequente é o lábio superior, mas pode ocorrer em outras regiões, como língua, mucosa jugal e palato. O seu tratamento depende, principalmente, do correto diagnostico da lesão, bem como da localização anatômica da mesma. A proposta deste artigo é relatar um caso de hemangioma em lábio superior tratado com esclerose terapêutica com oleato de monoetanolamina (Ethamolin®), considerando as características clínicas e os métodos de diagnóstico desta lesão. Por meio de um diagnóstico preciso e uma conduta terapêutica adequada, o caso apresenta-se com um acompanhamento de um ano, sem sinais de recidiva, e com um resultado estético funcional satisfatório, com regressão total da lesão...

Influência da composição dos gases durante a modificação da superfície por plasma na adesão de células primárias da polpa dental / Influence of the composition of gases during plasma surface modification on adhesion of primary cells from dental pulp

Amostras de titânio foram nitretadas por plasma usando duas composições gasosas: 80%H2-20%N2 e 20%H2-80%N2 e as propriedades físicas químicas desse tratamento foram estudas, bem como sua resposta biológica quando submetidas à cultura de células primárias da polpa dentária. Análise por difração de raios X indicam a formação de TiN nas duas amostras nitretadas ao contrário da superfície não nitretada que continha apenas a fase Ti-α. Verificaram-se modificações na dureza, topografia e molhabilidade dessas amostras quando comparadas às amostras não nitretadas. A adesão celular nessas amostras indica que o tratamento aumenta seu valor sendo superior para amostras tratadas em maior concentração de hidrogênio.

Samples of titanium were nitrided using plasma and a composition of two gases: 80% H2-20% N2 and 20% H2-80% N2. The influence of these treatments on their physical chemical properties and biological response when subjected to the primary cell culture of dental pulp were studied. Analyses by X-ray diffraction indicate the formation of TiN in both nitrided samples in contrast to the non-nitrided surface samples that contained only the Ti-α phase. Changes in hardness, topography and wettability of these samples compared to non-nitrided samples were found as well. Finally, the analysis of cell’s adhesion in these samples indicate that treatment increases its value being higher for samples treated at higher hydrogen concentration.

Avaliação clínica e histopatológica e hábitos associados ao surgimento de leucoplasias e eritroplasias orais / Clinical and histopathological evaluation and habits associated with the onset of oral leukoplakia and erythroplakia

Objective: This research aims to establish the prevalence, factors associated with the onset, and clinical and histopathological features of oral leukoplakia and erythroplakia, so that these data can contribute to the prevention of these lesions and, consequently, of oral cancer. Material and method: A retrospective study was conducted at a reference service of Universidade Federal do Rio Grande do Norte (UFRN) from 2000 to 2012. To verify the association of variables, Pearson's chi-squared test and Fisher's exact test (p ≤ 0.05) were used. Results: Among 6,560 investigated records, 54 cases were selected, of which 44.4% were male and 55.6% female, with mean age of 56.93 years. Regarding habits, 72.2% were smokers and 25% were alcohol users; 17.9% showed association of both habits. Oral leukoplakia lesions were the most prevalent (0.65%) and oral erythroplakia showed greater association with malignancy in the histopathological presentation (p = 0.001). Most lesions showed no symptoms (p = 0.004). The most frequent was oral leukoplakia in smoking women, with mean age of 57 years. Conclusion: Knowledge of associated factors and clinical characteristics of oral leukoplakia and erythroplakia is essential for establishing the correct diagnosis and treatment...

Objetivo: Esta pesquisa objetiva estabelecer a prevalência, os fatores associados ao surgimento e as características clínicas e histopatológicas das leucoplasias e eritroplasias orais, a fim de que estes dados possam contribuir na estratégia de prevenção ao desenvolvimento dessas lesões e, consequentemente, do câncer oral. Material e método: Foi realizado estudo retrospectivo em um serviço de referência da Universidade Federal do Rio Grande do Norte (UFRN) no período de 2000 a 2012. Para verificar a associação das variáveis foi utilizado o teste qui-quadrado e o exato de Fisher (p ≤ 0,05). Resultados: Foram investigados 6.560 prontuários, tendo sido selecionados 54 casos, dos quais 44,4% do sexo masculino e 55,6% do feminino, com idade média de 56,93 anos. Com relação aos hábitos, 72,2% eram fumantes e 25% usuários de álcool, sendo que 17,9% exibiam associação dos dois hábitos. As leucoplasias orais foram as lesões mais prevalentes (0,65%), e as eritroplasias orais apresentaram maior associação com apresentação maligna no diagnóstico histopatológico (p = 0,001). A maioria das lesões não apresentou sintomatologia (p = 0,004). A leucoplasia oral foi mais frequente em mulheres fumantes com média de idade de 57 anos. Conclusão: O conhecimento dos fatores associados e das características clínicas das eritroplasias e leucoplasias orais é essencial para o estabelecimento do correto diagnóstico e tratamento...

Proliferation of human periodontal ligament mesenchymal cells on polished and plasma nitriding titanium surfaces

Aim: To evaluate the proliferative capacity of mesenchymal cells derived from human periodontalligament on polished and plasma-treated titanium surfaces. Methods: Eighteen titanium disks werepolished and half of them (n=9) were submitted to plasma nitriding using the cathodic cage technique.Mesenchymal cells were isolated from periodontal ligament of impacted third molars (n=2) andcultured on titanium disks (polished and nitrided) and on a plastic surface as a positive control of cellproliferation. Cell proliferation was analyzed and growth curves were constructed for the differentgroups by determining the number of cells adhered to the different surfaces at 24, 48 and 72 h afterplating. Results: Higher cell number was observed for the nitrided surface at 24 and 48 h.However, no statistically significant difference in cell proliferation was observed between the twodifferent surface treatments (p>0.05). Conclusions: We concluded that plasma nitriding producedsurfaces that permitted the proliferation of human periodontal ligament mesenchymal cells. Associatedto other physical and chemical properties, it is possible to assume the feasibility of plasma nitridingmethod and its positive effect on the early cellular events of osseointegration.

Infected orthokeratinized odontogenic cyst: a rare cause of facial cellulitis

Orthokeratinized odontogenic cysts (OOCs) are relatively uncommon developmental cysts lined with orthokeratinized epithelium consisting of a prominent granular layer and a basal layer of low cuboidal flattened cells that show no tendency for nuclear palisading. These cysts have been considered a distinct entity from odontogenic keratocysts since they exhibit a less aggressive behavior and a very low rate of recurrence. Developmental odontogenic cysts can become infected but serious complications, such as potentially life-threatening cellulitis, are rare. This report describes a rare case of facial cellulitis secondary to an infected OOC located in the mandible of a 27-year-old man. The relevant literature about the clinical-pathological features of OOC is reviewed.

Os cistos odontogênicos ortoceratinizados (COOs) são cistos de desenvolvimento revestidos por epitélio ortoceratinizado constituído por uma camada granulosa proeminente e uma camada basal de células cuboidais achatadas que não mostram tendência à paliçada. Esses cistos foram considerados uma entidade distinta dos ceratocistos, uma vez que apresentam um comportamento menos agressivo e uma taxa muito baixa de recorrência. Cistos odontogênicos de desenvolvimento pode tornar-se infectados, mas complicações graves como a celulite, potencialmente ameaçadora da vida, são raros. Este relato descreve um caso raro de celulite facial secundária a um COO infectado localizado na mandíbula de um homem de 27 anos de idade. A literatura relevante sobre as características clínicopatológicas do COO foi revisada.

Utilização de matriz óssea desmineralizada para reparo de falhas ósseas / Use of demineralized bone matrix in the repair of bone defects

Introdução: Diversos biomateriais têm sido propostos como substituto do osso autógeno em procedimentos cirúrgicos, destacando-se a Matriz Óssea Desmineralizada (MOD). Objetivo: O presente trabalho consiste em uma revisão sistemática da literatura sobre a utilização da MOD aplicada à regeneração óssea. Material e método: Realizou-se uma busca nas bases de dados PubMed e Science Direct, limitada a artigos publicados em inglês, utilizando-se quatro descritores relacionados ao tema. Resultado: A literatura mostra que a MOD é um tipo de aloenxerto constituído principalmente por colágenos e diversos fatores de crescimento, e que apresenta um melhor desempenho quando comparado com o autoenxerto, pois proporciona uma boa capacidade osteoindutiva e não exige outro sítio cirúrgico para a sua obtenção. A MOD é considerada menos imunogênica do que o osso homólogo mineralizado e sua preparação promove a eliminação efetiva de vírus, como o HIV. Tem sido utilizada no reparo de falhas ósseas estáveis, como cavidades císticas, e no tratamento de fraturas maxilares, dentre outras. Note-se que seu desempenho depende de um bom estado geral de saúde do paciente. Conclusão: A MOD tem um amplo espectro de utilização clínica por suas características biológicas favoráveis; todavia, o entendimento de suas propriedades é necessário para determinar a escolha da MOD nos procedimentos cirúrgicos reparadores.

Introduction: Several biomaterials have been proposed as a substitute for autogenous bone in surgical procedures, highlighting the demineralized bone matrix (DBM). Objective: The paper consists of a systematic review of the literature on the use of DBM in the repair of bone defects. Material and method: The literature search was performed on PubMed and Science Direct databases, limited to papers published in English, using four search terms. Result: The literature shows that DBM is a type of allograft consisting of collagen and various growth factors, and it presents a better performance when compared to autograft - once it provides a good osteoinductive capacity and does not require another surgical site. DBM is considered less immunogenic than the mineralized bone and the preparation process promotes the effective elimination of viruses such as HIV. It has been used to repair stable bone defects as cystic cavities and for the treatment of jaw fractures, among others, and their performance depends on the patient?s general state of health. Conclusion: Due to its favorable biological characteristics, DBM has a broad spectrum of clinical use; however, the understanding of its properties is required to base their choice on surgical repair.

Infected orthokeratinized odontogenic cyst: a rare cause of facial cellulitis.

Orthokeratinized odontogenic cysts (OOCs) are relatively uncommon developmental cysts lined with orthokeratinized epithelium consisting of a prominent granular layer and a basal layer of low cuboidal flattened cells that show no tendency for nuclear palisading. These cysts have been considered a distinct entity from odontogenic keratocysts since they exhibit a less aggressive behavior and a very low rate of recurrence. Developmental odontogenic cysts can become infected but serious complications, such as potentially life-threatening cellulitis, are rare. This report describes a rare case of facial cellulitis secondary to an infected OOC located in the mandible of a 27-year-old man. The relevant literature about the clinical-pathological features of OOC is reviewed.

Bone marrow mesenchymal cell adhesion to polished and nitrided titanium surfaces

Aim: To evaluate the adhesion of mouse bone marrow mesenchymal cells (MBMMC) on differenttitanium surfaces. Methods: Grade II titanium discs (ASTM F86) received two different surfacetreatments: polished (S1) and cathodic cage plasma nitriding (S2). MBMMC were cultured ontitanium discs in 24-well cell culture plates, at a density of 1 x 104 cells per well. After 24 h, theadhesion was evaluated using a hemocytometer. Results: The mean adhesion was greater onS2, though without statistically significant difference from S2 (p>0.05). Conclusions: It wasdemonstrated that titanium surface treatment with ionic nitriding in a cathodic cage is biocompatiblesince it preserved the integrity of the cultivated MBMMC for a period of 24 h, allowing theiradhesion.