Establishing a role for the oral microbiome in infectious complications following major oral cavity cancer surgery.

Surgery forms the backbone of treatment for most locoregional or advanced oral cavity squamous cell carcinoma. Unfortunately, infectious complications (including orocutaneous fistulas) are common following such extensive surgery and can afflict over half of patients. These complications can lead to delays in adjuvant treatment, prolonged hospitalization, reconstructive failure, and decreased quality of life. The frequency and morbidity associated with infectious complications has led to the search for pre-disposing risk factors; and, several have been identified, including both patient (e.g. diabetes) and surgical (e.g. operative time) factors. However, these findings are inconsistently reproduced, and risk factor modification has had a limited impact on rates of infectious complications. This is striking given that the likely contaminant-the oral microbiome-is a well-studied microbial reservoir. Because many oral cavity cancer surgeries involve violation of oral mucosa and the spillage of the oral microbiome into normally sterile areas (e.g. the neck), variance in oral microbiome composition and function could underly differences in infectious complications. The goal of this perspective is to highlight 1) this knowledge gap and 2) opportunities for studies in this domain. The implication of this line of thought is that the identification of oral microbial dysbiosis in patients undergoing surgery for oral cavity cancer could lead to targeted pre-operative therapeutic interventions, decreased infectious complications, and improved patient outcomes.

Systematic review of minimally-invasive reconstructive options for oral cavity defects.

The oral cavity is a primary site for malignant neoplasms of the head and neck region. Surgery, with or without adjuvant therapy, offers the highest probability of cure by focusing on radical tumour removal and organ function restoration. Reconstructive options are represented by local and free flaps, while small defects can be managed without reconstruction. For medium-sized defects without bone involvement, local flaps can be a good alternative to free flaps in selected patients. The purposes of this article are to analyse the main minimally-invasive reconstructive techniques in oral cancer surgery through a systematic review of the literature and develop a reconstructive algorithm based on the site and size of the defect. We defined minimally-invasive reconstruction as any reconstructive option not involving flap dissection from the neck or other distant areas from the oral cavity. Options considered include: local myo-mucosal or mucosal flaps (based on the facial or buccal arteries, and palatal flap), Bichat's fat pad flap, and nasolabial flap. Use of biological or synthetic materials is also described. In selected patients with small to moderate-sized defects, the possibility of reconstruction with local flaps can be a viable option.

Feasibility and complications after transoral endoscopic thyroidectomy via vestibular approach (TOETVA) - a single-center first experience case series.

BACKGROUND: This paper reports on the first experience after implementation of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) as an alternative to (partial) thyroidectomy or isthmusectomy in a single center. Feasibility, implementation and specific complications are addressed. METHODS: All patients who underwent a TOETVA procedure in our center between November 2019 and March 2023 were included. The surgical technique was performed as described by Anuwong et al. All procedures were performed by two dedicated head- and neck surgeons. RESULTS: A total of 20 patients were included. All patients underwent TOETVA surgery as planned and no conversions were needed. Observed complications were post-operative wound infections (POWI) (2/20; 10%), clinically significant seroma (1/20, 5%) and unilateral hemiparesis of the larynx (3/20; 15%). Permanent mental nerve damage was seen in 3/20 patients (15%), and 4 other patients (20%) experienced transient neuropraxia. CONCLUSIONS: TOETVA is a feasible alternative to (partial) thyroidectomy or isthmusectomy in selected patients. Special care should be taken when placing the trocars in the oral vestibulum to prevent mental nerve damage. Experience and training are essential for implementing the TOETVA procedure. TRIAL REGISTRATION: This study was registered to ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT05396703.

An Imaging-Compatible Oral Retractor System for Transoral Robotic Surgery.

This study aimed to develop and validate a Computed Tomography (CT)/Magnetic Resonance Imaging (MRI)-compatible polymer oral retractor system to enable intraoperative image guidance for transoral robotic surgery (TORS). The retractor was designed based on standard-of-care metallic retractors and 3D (three-dimensional) printed with carbon fiber composite and nylon. The system was comprehensively evaluated in bench-top and cadaveric experiments in terms of its ability to enable intraoperative CT/MR images during TORS, functionality including surgical exposure and working volume, usability, compatibility with da Vinci surgical systems, feasibility for disinfection or sterilization, and robustness over an extended period of time. The polymer retractor system enabled the acquisition of high-resolution and artifact-free intraoperative CT/MR images during TORS. With an inter-incisive distance of 42.55 mm and a working volume of 200.09 cm3, it provided surgical exposure comparable to standard-of-care metallic retractors. The system proved intuitive and compatible with da Vinci S, Xi, and Single Port systems, enabling successful mock surgical tasks performed by surgeons and residents. The retractor components could be effectively disinfected or sterilized for clinical use without significant compromise in material strength, with STERRAD considered the optimal method. Throughout a 2 h mock procedure, the retractor system showed minimal displacements (<1.5 mm) due to surrounding tissue deformation, with insignificant device deformation. The 3D-printed polymer retractor system successfully enabled artifact-free intraoperative CT/MR imaging in TORS for the first time and demonstrated feasibility for clinical use. This breakthrough opens the door to surgical navigation with intraoperative image guidance in TORS, offering the potential to significantly improve surgical outcomes and patients' quality of life.

Combined Transnasal, Transoral Excision of Odontogenic Cysts Offers Reduced Recurrence Rates and Favorable Sinonasal Outcomes.

Odontogenic cysts impact the adjacent dentition and maxillary sinus. A combined transnasal, transoral approach for removal offers reduced recurrence rates and favorable sinonasal outcomes compared with historic transoral-only approaches.

Medial sural artery perforator free flap versus radial forearm free flap in oral cavity reconstruction and donor site morbidity.

OBJECTIVE: Radial Forearm Free flap (RFFF) is widely used in head and neck reconstruction, yet its donor site defect remains a significant drawback. The Medial Sural Artery Perforator Free Flap (MSAPFF) is considered an alternative flap to RFFF. This study aims to comprehensively analyze their characteristics, outcomes, and their impact on patient quality of life. METHODS: All patients who underwent oral cavity reconstruction using RFFF and MSAPFF between February 2017 and April 2023 were included in this study. Flap characteristics, outcomes and post-operative complications were recorded and compared. Subjective donor site morbidity, aesthetic and functional results, and quality of life were also analyzed. RESULTS: The study included 76 patients: 37 underwent reconstruction with RFFF, and 39 with MSAPFF. There was no significance difference between the RFFF and MSAPFF regarding the success rate (97.2% vs 97.4%), flap size (4.8 × 8.8 cm2 vs 5 × 9.8 cm2), hospital of stay (15.5 days vs 13.5 days) and recipient site complications (P > 0.05). However, MSAPFF showed larger flap thickness (P = 0.001), smaller arterial caliber (P = 0.008), shorter pedicle length (P = 0.001), and longer harvesting time (P < 0.001). No significant difference was observed between the pre-and postoperative ranges of wrist and ankle movements or in recipient site complications. MSAPFF showed a significant difference in donor site morbidity (P < 0.05). CONCLUSION: The MSAPFF is an excellent alternative to the RFFF for repairing oral cavity defects, with additional advantage of a well-hidden scar on the posterior calf, a larger flap thickness, accepted pedicle length and arterial caliber. However, one should consider the harvesting time and surgical skills required in comparison to the RFFF. CLINICAL RELEVANCE: The study highlights the importance of the MSAPFF as an alternative option for RFFF with less donor site morbidity and high success rate in oral cavity reconstruction and improved patient Quality of life after ablative surgery.

Prospective development study of the Versius Surgical System for use in transoral robotic surgery: an IDEAL stage 1/2a first in human and initial case series experience.

PURPOSE: Transoral robotic surgery is well established in the treatment paradigm of oropharyngeal pathology. The Versius Surgical System (CMR Surgical) is a robotic platform in clinical use in multiple specialities but is currently untested in the head and neck. This study utilises the IDEAL framework of surgical innovation to prospectively evaluate and report a first in human clinical experience and single centre case series of transoral robotic surgery (TORS) with Versius. METHODS: Following IDEAL framework stages 1 and 2a, the study evaluated Versius to perform first in human TORS before transitioning from benign to malignant cases. Iterative adjustments were made to system setup, instrumentation, and technique, recorded in accordance with IDEAL recommendations. Evaluation criteria included successful procedure completion, setup time, operative time, complications, and subjective impressions. Further evaluation of the system to perform four-arm surgery was conducted. RESULTS: 30 TORS procedures were successfully completed (15 benign, 15 malignant) without intraoperative complication or conversion to open surgery. Setup time significantly decreased over the study period. Instrumentation challenges were identified, urging the need for TORS-specific instruments. The study introduced four-arm surgery, showcasing Versius' unique capabilities, although limitations in distal access were observed. CONCLUSIONS: TORS is feasible with the Versius Surgical System. The development of TORS-specific instruments would benefit performance and wider adoption of the system. 4-arm surgery is possible however further evaluation is required. Multicentre evaluation (IDEAL stage 2b) is recommended.

Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta-analysis.

BACKGROUND: Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6-14 days post-operatively due to concern for orocutaneous fistula development. METHODS: Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used. RESULTS: One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = -0.02, p = 0.06) or free flap failure (RD = -0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = -2.43, p < 0.01). CONCLUSIONS: While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.

Hyperspectral imaging for monitoring of free flaps of the oral cavity: A feasibility study.

OBJECTIVES: Hyperspectral imaging (HSI) provides spectral information about hemoglobin, water and oxygen supply and has thus great potential in perfusion monitoring. The aim of the present study was to investigate the feasibility of HSI in the postoperative monitoring of intraoral free flaps. METHODS: The 14 patients receiving reconstructive head and neck surgery with a radial forearm free flap were included. HSI was performed intraoperatively (t0), on Day 1 (t1), 2 (t2), 3-6 (t3), 7-9 (t4), 10-11 (t5) and 12-15 (t6) postoperatively. Flap tissue perfusion was assessed on defined regions of interest by calculating the perfusion indices Tissue Hemoglobin Index (THI), hemoglobin oxygenation (StO2 ), Near Infrared Perfusion Index (NIR Perfusion Index) and Tissue Water Index (TWI). RESULTS: Image quality varied depending on location of the flap and time of measurement. StO2 was >50 intraoperatively and >40 on t1 for all patients. A significant difference was found solely for TWI between t0 and t2 and t0 and t4. No flap loss occurred. CONCLUSIONS: The use of HSI in the monitoring of intraoral flaps is feasible and might become a valuable addition to the current clinical examination of free flaps.

Déficit adquirido de Factor XIII como causa de hemorragia masiva con compromiso de vía aérea superior en cirugía oncológica de cavidad oral / Acquired Factor XIII deficiency as a cause of massive hemorrhage with upper airway compromise in oncological surgery of the oral cavity

El diagnóstico etiológico de una hemorragia postoperatoria persistente en pacientes adultos sin antecedentes médicos de interés supone un reto a día de hoy. Dentro de las distintas causas encontramos el déficit adquirido del Factor XIII (F. XIII) de la coagulación. El déficit de este factor suele pasar desapercibido al no ser valorado en el estudio preoperatorio rutinario. Presentamos el caso de un varón de 70 años con déficit de F. XIII adquirido, no diagnosticado previamente, que tras ser intervenido por un carcinoma epidermoide de suelo de boca sufrió un sangrado de cavidad oral y cervical bilateral con compromiso de la vía aérea. (AU)

The etiological diagnosis of persistent postoperative bleeding in adult patients with no relevant medical history is currently a challenge. Among the different causes, we find the acquired deficiency of Factor XIII (F. XIII) of coagulation. The deficit of this factor usually goes unnoticed as it is not tested in the routine preoperative studies. We present the case of a 70-year-old man with previously undiagnosed acquired F. XIII deficiency who, after undergoing surgery for squamous cell carcinoma of the floor of the mouth, suffered oral and bilateral cervical bleeding causing airway compromise. (AU)

Maxilectomia em paciente diabética tipo II, diagnosticada com Mucormicose rinomaxilar, com posterior reabilitação protética: relato de caso / Maxillectomy in a type II diabetic patient, diagnosed with rhinomaxillary mucormycosis, with subsequent prosthetic rehabilitation: case report / Maxilectomía en paciente diabética tipo II diagnosticada de mucormicosis rinomaxilar, con posterior rehabilitación protésica: reporte de caso

A mucormicose é uma infecção fúngica angioinvasiva que afeta uma ampla faixa etária, geralmente imunodeprimidos, sem predileção por gênero ou raça e com alta taxa de mortalidade. Essa infecção inicia se no nariz, devido à inalação dos esporos, podendo-se espalhar pelos seios paranasais, órbita e estruturas intracranianas. As características clínicas incluem parestesia perinasal, celulite periorbitária, rinorréia, obstrução nasal, epistaxe e diminuição de peso. O tratamento efetivo dessa comorbidade compoe uma combinação de manejo clínico e medicamentoso, conjuntamente com desbridamento cirúrgico radical do tecido infectado e/ou necrótico. O caso clínico descrito nesse trabalho refere-se a uma paciente diagnosticada com Mucormicose rino maxilar e diabetes do tipo II, a qual foi submetida a procedimento cirúrgico de hemimaxilectomia do lado esquerdo com posterior reabilitação protética para selamento de comunicação buco-naso-sino-etmoidal... (AU)

Mucormycosis is an angioinvasive fungal infection that affects a wide age group, usually immunocompromised, with no gender or race predilection, and with a high mortality rate. This infection starts in the nose, due to the inhalation of spores, and can spread through the paranasal sinuses, orbit and intracranial structures. Clinical features include perinasal paresthesia, periorbital cellulitis, rhinorrhea, nasal obstruction, epistaxis and weight loss. Effective treatment of this comorbidity comprises a combination of clinical and drug management, together with radical surgical debridement of infected and/or necrotic tissue. The clinical case described in this work refers to a patient diagnosed with Mucormycosis Rhinomaxilla and Type II diabetes, who underwent a surgical procedure of left hemimaxillectomy with subsequent prosthetic rehabilitation for sealing of the bucco nasal-sino-ethmoidal communication... (AU)

La mucormicosis es una micosis angioinvasiva que afecta a un amplio grupo de edad, habitualmente inmunodeprimidos, sin predilección de género ni raza, y con una alta tasa de mortalidad. Esta infección comienza en la nariz, debido a la inhalación de esporas, y puede extenderse a través de los senos paranasales, la órbita y las estructuras intracraneales. Las características clínicas incluyen parestesia perinasal, celulitis periorbitaria, rinorrea, obstrucción nasal, epistaxis y pérdida de peso. El tratamiento eficaz de esta comorbilidad comprende una combinación de manejo clínico y farmacológico, junto con un desbridamiento quirúrgico radical del tejido infectado y / o necrótico. El caso clínico descrito en este trabajo se refiere a una paciente diagnosticada de Mucormicosis Rinomaxilar y diabetes Tipo II, que fue sometida a un procedimiento quirúrgico de hemimaxilectomía izquierda con posterior rehabilitación protésica para sellar la comunicación buco-nasal-sino-etmoidal... (AU)

Patologías del área oral en los recién nacidos e infantes: frenillos y las aportaciones de los sistemas láser / Pathologies of the oral area in newborns and infants: frenula and contributions of laser systems

El propósito de este artículo es mejorar nuestro conocimiento sobre las estructuras y función de los diferentes elementos presentes en la boca del recién nacido, ya que en ocasiones los odontólogos no recuerdan la importancia de la boca en el desarrollo general del lactante y la necesidad de una intervención temprana con láseres para ayudarles a obtener un buen estado de su sistema oral. Realizamos una exploración clínica integral del paciente con el fin de realizar un diagnóstico más preciso. Cuando la cirugía sea necesaria, recomendamos utilizar láseres de Erbio siempre que sea posible (láser de 2780nm Er, Cr: YSGG o un Er: YAG de 2940nm), ya que es una opción rápida y eficaz para tratar estas lesiones orales, especialmente los frenillos labiales o linguales que pueden poner en riesgo el acto de amamantar; Asimismo podemos utilizar láseres de diodo (810nm, 940nm, 980 nm o un láser Nd: YAG de 1064nm o de CO2 10.600- 9600 nm) con sus gafas de seguridad específicas. Estos sistemas láser utilizados por un profesional certificado, en colaboración con un personal debidamente entrenado, son un factor muy importante durante la cirugía. Al tener un conocimiento adecuado de las estructuras orales y sus patologías, podemos diagnosticar si esos trastornos deben tratarse quirúrgicamente y, de ser así, cómo proceder con los sistemas láser, ya que son procedimientos mínimamente invasivos; o si debiésemos recomendar a los padres que visiten a un terapeuta miofuncional para ayudar a recuperar la función normal. La comprensión de las estructuras orales de los recién nacidos es muy importante para promover el desarrollo del crecimiento craneofacial y para brindar un servicio importante a las madres, dándoles a sus bebés un buen comienzo en la vida desde una etapa muy temprana. Necesitamos mejorar la colaboración entre profesionales de diferentes disciplinas con el fin de mejorar nuestro conocimiento.

The purpose of this article is to improve our knowledge about the structures and function of the different elements present in the mouth of newborns since dentists sometimes do not remember the importance of the mouth in the general development of infants and the need for an early intervention with lasers to help them obtain a good state of their Oral System. We performed a comprehensive clinical exploration of the patient in order to make a more accurate diagnosis. When surgery is necessary, we recommend to use erbium lasers when possible (2780nm Er, Cr: YSGG laser or a 2940nm Er: YAG), as they are a quick and effective option to treat these oral lesions, especially lip or tongue ties which can risk the act of breastfeeding; moreover, we can also use diode lasers (810nm, 940nm, 980nm or a 1064nm Nd:YAG laser or CO2 10.600-9600 nm.) al lof them with their specifical safety goggles. These laser systems used by a certified professional, in collaboration with a properly trained staff, are a very important factor during the surgery.By having proper knowledge of the oral structures and their pathologies, we are able to diagnose whether those disorders should be surgically treated and if so, how to proceed with laser systems as they are minimally invasive procedures; or if we should recommend parents to visit a myofunctional therapist in order to help recover the normal function.The understanding of oral structures of newborns is very important in order to improve the development of craniofacial growth and provide an important service to mothers by giving their babies a right start in life from a very early stage. We need to improve collaboration between professionals from different disciplines in order to enhance our knowledge.

Volumetric changes in alveolar ridge preservation with a compromised buccal wall: a systematic review and meta-analysis

BACKGROUND: Many studies have addressed socket preservation, though fewer publications considering buccal wall loss can be found, since the literature typically considers sockets with four walls. A systematic review was made on the influence of type II buccal bone defects, according to Elian's Classification, in socket grafting materials upon volumetric changes in width and height. MATERIAL AND METHODS: An electronic and manual literature search was conducted in accordance to PRISMA statement. The search strategy was restricted to randomized controlled trials (RCTs) and controlled clinical trials (CCTs) describing post-extraction sockets with loss of buccal wall in which alveolar ridge preservation (ARP) was carried out in the test group and spontaneous healing of the socket (SH) was considered in the control group. RESULTS: The search strategy yielded 7 studies. The meta-analysis showed an additional bone loss of 2.37 mm in width (p > 0.001) and of 1.10 mm in height (p > 0.001) in the absence of ARP. The reconstruction of the vestibular wall was not evaluated in any study. The results also showed moderate to great heterogeneity among the included studies in terms of the changes in width and height. CONCLUSIONS: Despite the heterogeneity of the included studies, the results indicate a benefit of ARP versus SH. Further studies are needed to determine the volumetric changes that occur when performing ARP in the presence of a buccal bone wall defect

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Relationship between acetaldehyde concentration in mouth air and characteristics of microbiota of tongue dorsum in Japanese healthy adults: a cross-sectional study

Abstract Acetaldehyde, associated with consumption of alcoholic beverages, is known to be a carcinogen and to be related to the tongue dorsum. Objective The aim of this study was to investigate the relationship between acetaldehyde concentration in mouth air and bacterial characteristics on the tongue dorsum. Methodology Thirty-nine healthy volunteers participated in the study. Acetaldehyde concentrations in mouth air were evaluated by a high-sensitivity semiconductor gas sensor. A 16S rRNA gene sequencing technique was used to compare microbiomes between two groups, focusing on the six samples with the highest acetaldehyde concentrations (HG) and the six samples with lowest acetaldehyde concentrations (LG). Results Acetaldehyde concentration increased in correlation with the increase in bacterial count (p=0.048). The number of species observed in the oral microbiome of the HG was higher than that in the oral microbiome of the LG (p=0.011). The relative abundances of Gemella sanguinis, Veillonella parvula and Neisseria flavescens in the oral microbiome of the HG were higher than those in the oral microbiome of the LG (p<0.05). Conclusion Acetaldehyde concentration in mouth air was associated with bacterial count, diversity of microbiome, and relative abundance of G. sanguinis, V. parvula, and N. flavescens.

Bichectomia e sua contribuição para harmonia facial / Bichectomy and its contribution to facial harmony

Introdução: O tecido gorduroso bucal foi descrito pela primeira vez em 1732, por Heister. Em 1802, Bichat diagnosticou sua natureza adiposa. Há uma estreita relação entre a gordura bucal e músculos da mastigação, auxiliando os lactentes na sucção do leite por atuar com um tecido de deslizamento. Sua projeção diminui com o aumento da idade, tanto pela redução discreta de seu volume quanto pelo crescimento facial. A bichectomia ou bichatectomia é o procedimento cirúrgico que visa remover a "bola gordurosa de Bichat", com fins estéticos e/ ou funcionais. O objetivo é demonstrar que a bichectomia é um procedimento de baixo risco cirúrgico e com bons resultados, desde que seja bem indicada e siga os padrões técnicos, respeitando a anatomia das estruturas faciais. Métodos: Estudo prospectivo de coorte, realizado entre janeiro de 2016 e abril de 2018, totalizando 59 pacientes, com média de idade de 31 anos. O tempo de seguimento foi de 12 a 26 meses. Resultados: Foram avaliados 59 pacientes, com média de idade de 31 anos, sendo 46 do sexo feminino e 13 do sexo masculino. Todos os pacientes receberam alta no mesmo dia. Em média, foram retirados 3,2ml de volume da gordura de Bichat. Conclusão: A retirada de porções das gorduras de Bichat é segura, desde que sejam observados os detalhes anatômicos. Pode oferecer maior harmonia entre os três terços da face. O sucesso dos resultados depende de uma indicação precisa para o procedimento.

Introduction: Buccal fat removal was described for the first time by Heister in 1732. In 1802, Bichat identified the adipose nature of this tissue. There is a close association between buccal fat and masticatory muscles, which helps infants suck owing to the sliding motion of the tissues. Its prominence diminishes with age, both through modest reduction in volume and facial growth. Bichectomy or bichatectomy is a surgical procedure that involves extraction of Bichat's fat pad for aesthetic and/or functional purposes. This study aimed to show that bichectomy is a low-risk surgical procedure with good results, provided it is appropriately indicated and is performed following technical standards according to the anatomy of the facial structures. Methods: This prospective cohort study was conducted between January 2016 and April 2018 and included 59 patients with a mean age of 31 years. The follow-up time was 12-26 months. Results: Of 59 patients, 46 were female, and 13 were male. All patients underwent same-day surgery. On average, 3.2 mL of fat was removed. Conclusion: Removal of Bichat's fat according to anatomical principles is safe. This technique can improve facial harmony. Success depends on application of appropriate techniques.

Buccal fat pad removal to improve facial aesthetics: an established technique?

BACKGROUND: Buccal fat pad (BFP) is a singular structure between the facial muscles. Its removal may enhance the zygomatic prominences resulting in an inverted triangle of beauty. OBJECTIVE: The aim of this study was to perform a systematic review of literature about BFP removal for facial aesthetic improvement. In order to answer the following research question: What are the indications, complication types and rates, surgical techniques and outcomes of the technique?. MATERIAL AND METHODS: The initial search in Pubmed, Scopus, and Cochrane databases recognized 220 articles. The final review included eight of them. None of the included studies were clinical trials. RESULTS: BPF removal was performed by intraoral incision or associated with the face lift procedure. In 71 patients submitted to the procedure and evaluated about complications, only 8.45% presented minor complications. Parotid duct and facial nerve injuries were not found. No study evaluated facial aging and long-term effects, therefore the harmless effect of the procedure to those features is not clear. CONCLUSIONS: Although it is not a novel procedure, there is a lack of information about long-term outcomes. Thus, controlled clinical studies should be performed to achieve adequate clinical evidence of those aspects

Tratamento cirúrgico de lipoma: relato de dois casos / Surgical Treatment of Lipoma: Report of two cases

O lipoma é um tumor mesenquimal benigno, considerado um dos mais comuns dos tecidos moles. Ocorre, principalmente, no tronco, nas porções proximais das extremidades do corpo e na região de cabeça e pescoço, com incidência de 15 a 20% dos casos. Quando apresentado em região oral e maxilofacial, é relativamente raro, tendo uma incidência relativa de 1% - 4% dos tumores que acometem essa região. Clinicamente a lesão intraoral apresenta-se como aumento de volume nodular, assintomática, bem-circunscrita, de crescimento lento, com superfície lisa e consistência macia, que pode ser séssil ou pedunculada, de tamanho diverso, com coloração variando de amarelo discreto, em lesões superficiais, a rosa, semelhante à mucosa em lesões mais profundas. O trabalho tem como objetivo relatar dois casos de lipomas em regiões maxilofaciais, tratados cirurgicamente sob anestesia local e geral. Os pacientes encontram-se em acompanhamento, sem sinais de recidiva. É importante o correto diagnóstico clínico e anatomopatológico da lesão, para que seja definido o tratamento ideal e um bom prognóstico, já que essa lesão apresenta uma baixa taxa de recidiva... (AU)

Lipoma is a benign mesenchymal tumor, considered one of the most common one in soft tissues. They mainly occur in the trunk, in the proximal portions of the extremities of the body and in the region of the head and the neck, with incidence of 15 to 20% of cases. When present in the oral and maxillofacial regions, it is relatively rare, with a relative incidence of 1% -4% of the tumors affecting this region. Clinically, the intraoral lesion presents as a nodular volume increase, asymptomatic, well-circumscribed, slow-growing, with smooth surface and soft consistency - which may be sessile or pedunculated - of different size, with a coloration ranging from discrete yellow in superficial lesions to a mucosa-like pink in deeper lesions. The aim of this study is to report two cases of lipomas in maxillofacial regions surgically treated under local and general anesthesia. Patients are being followed up without signs of relapse. The appropriate clinical and pathological diagnosis of the lesion is important to define the ideal treatment and a good prognosis, since this lesion presents a low rate of recurrence... (AU)

Fascitis nodular de presentación intraoral. Revisión / Oral nodular fasciitis. Review

La fascitis nodular es una proliferación benigna de fibroblastos y miofibroblastos, previamente descrita como de naturaleza reactiva. Resulta extremadamente rara la presentación en la cavidad bucal. La ubicación predilecta es la mucosa yugal. Clínicamente se observa un tumor de rápido y brusco crecimiento, bordes bien circunscritos, consistencia firme a la palpación, coloración similar a la mucosa normal e indolora. El tratamiento definitivo consiste en la escisión completa de la lesión; las recidivas son excepcionales. Se presenta un caso clínico en una mujer de 23 años de edad con un tumor en encía inferior, de 2 meses de evolución. Se realizó la escisión quirúrgica con diagnóstico de fascitis nodular sin que se observara recurrencia a los 18 meses. Además, se revisan los casos publicados de fascitis nodular de presentación intraoral en los últimos 20 años (AU)

Nodular fasciitis is a benign proliferation of fibroblasts and myofibrobasts, previously described as one of reactive nature. Intraoral presentation is very rare. Clinically, lesions are described as rapid growth masses, well-circumscribed, of elastic consistency and asymptomatic. Treatment of choice consists in complete excision, while recurrences are exceptional. We describe a case in a 23 year-old woman; with an inferior gum tumor which had grown in 2 months. A complete excision was performed arriving to a diagnosis of nodular fasciitis; with an 18 month follow-up without recurrence. Moreover, a review of oral nodular fasciitis of the cases published over the last 20 years is done (AU)

Oral cysticercosis in the paediatric patient: report of six cases / Cisticercosis oral en el paciente pediátrico: informe de seis casos

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The implications of different lateral wall thicknesses on surgical access to the maxillary sinus

Abstract: The objective of this study was to measure the topographic thickness of the lateral wall of the maxillary sinus in selected Asian populations. Measurements were made on the lateral walls of maxillary sinuses recorded using CBCT in a convenient sample of patients attending an Asian teaching hospital. The points of measurement were the intersections between the axes along the apices of the canine, first premolar, and second premolar and along the mesiobuccal and distobuccal apices of the first and second molars and horizontal planes 10 mm, 20 mm, 30 mm and 40 mm beneath the orbital floor. The CBCT images of 109 patients were reviewed. The mean age of the patients was 33.0 (SD 14.8) years. Almost three quarters (71.8%) of the patients were male. The mean bone thickness decreased beginning at the 10-mm level and continuing to 40 mm below the orbital floor. Few canine regions showed encroachment of the maxillary sinus. The thickness of the buccal wall gradually increased from the canine region (where sinus encroachment of the canine region was present) to the first molar region, after which it decreased to the thickness observed at the canine region. The buccal wall of the maxillary sinus became thicker anteroposteriorly, except in the region of the second molar, and thinner superoinferiorly. These changes will affect the approach used to osteotomize the lateral sinus wall for oral surgery and for the sinus lift procedure.