A Rare Odontogenic Cyst in an Uncommon Area: Case Report and Review of the Literature / Um cisto odontogênico raro em uma área incomum: Relato de caso e revisão da literatura

Abstract Objective Orthokeratinized odontogenic cyst is a rare developmental odontogenic cyst of the jaws. It is a less aggressive intraosseous cyst identified by an orthokeratinized epithelium. Case Report A 50-year-old male patient with the chief complaint of swelling in the anterior part of his face, and, intraorally, there was diffuse swelling in the palatal cortex. On panoramic radiography, there was a well-defined unilocular radiolucency on the right side of the maxilla and palatal cortical expansion, and thinning of the buccal and palatal cortexes was observed. The histopathological examination revealed a pathologic cyst that was lined by a thick orthokeratinized epithelium. Therefore, the diagnosis was orthokeratinized odontogenic cyst. Conclusion The orthokeratinized odontogenic cyst displays characteristic clinical, histopathological, and biological features that differ significantly from those of keratocystic odontogenic tumor (KCOT), but it has a better prognosis and lower recurrence rate. Thus, other radiolucent lesions of the jaws, including keratocystic odontogenic tumor (KCOT), must be considered in the differential diagnosis.

Resumo Objetivo O cisto odontogênico ortoceratinizado é um raro cisto odontogênico maxilar. É um cisto intraósseo menos agressivo, identificado por um epitélio ortoceratinizado. Relato de caso Um paciente do sexo masculino, de 50 anos de idade, com queixa principal de edema na parte anterior da face, e, intraoralmente, havia edema difuso no córtex palatal. Na radiografia panorâmica, havia uma radioluminescência unilocular bem definida no lado direito da maxila e expansão cortical palatina, e desbastamento dos córtex vestibular e palatino. O exame histopatológico revelou cisto patológico revestido por espesso epitélio ortoceratinizado. Logo, o dignóstico foi de cisto odontogênico ortoceratinizado. Conclusão O cisto odontogênico ortoceratinizado apresenta características clínicas, histopatológicas e biológicas que diferem significativamente das do tumor odontogênico ceratocístico (TOC), mas tem melhor prognóstico e menor taxa de recorrência. Portanto, outras lesões radiolúcidas dos maxilares, incluindo TOC, devem ser consideradas no diagnóstico diferencial.

Incident injury is strongly associated with subsequent incident temporomandibular disorder: results from the OPPERA study.

Cross-sectional studies confirm, as expected, a positive association between jaw injury and painful temporomandibular disorders (TMDs), but prospective evaluations are lacking. We prospectively assessed incident jaw injury, injury type, and development of TMD in adults aged 18 to 44 years. Data were collected from 3258 individuals from communities surrounding 4 US academic institutes between 2006 and 2008. At enrollment, participants reported no TMD history and no facial injuries in the previous 6 months. Quarterly, follow-up questionnaires assessed incident jaw injury, which was classified as intrinsic (attributed to yawning or prolonged mouth opening) or extrinsic (attributed to other causes). Examiners classified incident TMD during a median follow-up period of 2.8 years (range 0.2-5.2 years). Cox regression models used jaw injury as a time-dependent covariate to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association with incident TMD. Among 1729 participants with complete data, 175 developed TMD. Eighty percent of injuries were intrinsic. Temporomandibular disorder annual incidence was nearly twice as high in those experiencing jaw injury (5.37%) compared with those who did not (3.44%). In the Cox model that accounted for timing of injury, the corresponding HR was 3.94 (95% CI = 2.82-5.50) after adjusting for study site, age, race, and sex. Hazard ratios did not differ (P = 0.91) for extrinsic injuries (HR = 4.03, 95% CI = 2.00-8.12) and intrinsic injuries (HR = 3.85, 95% CI = 2.70-5.49). Jaw injury was strongly associated with incident TMD. If surveillance and intervention after jaw injury is to be effective in preventing TMD, they should focus on both intrinsic and extrinsic injuries.

A Novel Silicon Device for the Packing of Cutaneous Abscesses.

BACKGROUND: Superficial skin abscesses are commonly encountered in emergency medicine practice. Standard treatment includes incision, drainage, and often packing with a gauze strip. The packing component of the procedure has several negative potential outcomes, is painful, and necessitates a return visit for removal. DISCUSSION: Here we report the first case in which a novel silicon packing device was utilized. The patient presented with a facial abscess, which was incised and drained. The novel device was inserted, and removed by the patient independently, without complication. Both patient and provider reported satisfaction with the novel procedure, and noted low pain scores. CONCLUSIONS: This device has the potential to replace traditional packing, and will require further study through a controlled trial to assess for safety and efficacy.

Photomodulation multiple sessions as a promising preventive therapy for medication-related osteonecrosis of the jaws after tooth extraction in rats.

The aim of this study was to evaluate the effects of photobiomodulation (PBM) with multiple sessions of low-level laser on the alveolar repair process of rats with major risk factors for medication-related osteonecrosis of the jaws (MRONJ). Senile rats received 0.45 mL of vehicle (VEH and VEH-PBM) or 0.45 mL of 100 µg/kg zoledronate (ZOL and ZOL-PBM) administrated intraperitoneally every two days during seven weeks. After three weeks of initiation of drug treatment the first lower left molar was extracted. No local treatment was performed in VEH and ZOL. VEH-PBM and ZOL-PBM were submitted to laser irradiation (660 ±â€¯10 nm; 0.035 W; 2.1 J; 60 s) on the extraction site at 0, 2 and 4 days postoperatively. Euthanasia was performed 28 days after tooth extraction. Histological sections of the hemimandible were submitted to histopathological and histomorphometric analysis, as well as to histochemistry for collagen fiber maturation and immunohistochemistry for pro-inflammatory cytokines. In ZOL, general impairment of tissue repair, areas with osteonecrosis, lower newly formed bone tissue (NFBT), smaller amount of mature collagen fibers and increased immunoreactivity for TNFα, IL-1ß and IL-6 were observed when compared to VEH and VEH-PBM. ZOL-PBM showed significant improvement in some parameters compared to ZOL, such as positive repair tissue, higher NFBT, greater amount of mature collagen fibers, besides TNFα and IL-1ß immunoreactivity decrease. Zoledronate treatment severely compromised the tissue repair process of the tooth extraction site in rats with major risk factors for MRONJ. Based on parameters employed in the present study, PBM in multiple sessions can improve the alveolar repair process, constituting a promising preventive therapy to avoid the onset of post-extraction MRONJ.

Suffocation due to Acute Airway Edema in a Patient with Hereditary Angioedema Highlighted the Need for Urgent Improvements in Treatment Availability in Japan.

A 42-year-old Japanese man with hereditary angioedema suffered accidental trauma to his jaw in Shizuoka Prefecture, Japan, which gradually caused facial edema. Since plasma-derived human C1 inhibitor (pdh C1-INH) was unavailable, he had to be transferred to Juntendo University Hospital in Tokyo. Due to his severe edema, he suffered asphyxiation leading to cardiopulmonary arrest upon arrival. The patient was resuscitated and promptly treated with pdh C1-INH. In Japan, the self-administration of pdh C1-INH is not allowed, and every prefecture does not always possess stocks of pdh C1-INH. This case emphasizes the need for urgent improvements in treatment availability in Japan.

Self-inflicted face gunshot injuries: two case reports.

Self-inflicted gunshot injuries to the head and neck area are challenging cases. Immediate and complex approach is required due to complexity of head and neck anatomy. The extent of injury largely depends on velocity of a rifle and penetrated tissues. Management of these type of patients consist of vital resuscitation, primary wound management, soft and hard tissue reconstruction and rehabilitation. Here we present two cases of self-inflicted gunshot injuries with low and high velocity rifles.

Stem cell therapy for reconstruction of alveolar cleft and trauma defects in adults: A randomized controlled, clinical trial.

BACKGROUND: Stem cell therapy with bone marrow-derived mesenchymal stem cells is a promising tissue engineering strategy to promote regeneration of craniofacial bone. PURPOSE: To determine whether cell therapy with ex vivo expanded stem cell populations would be safe and efficacious in the regeneration of large alveolar defects in patients with a history of cleft palate or craniofacial trauma. MATERIALS AND METHODS: Eighteen patients (10 patients with traumatic injury and 8 patients with cleft palate) presenting with missing teeth associated with horizontal alveolar bone deficiencies were included in this randomized controlled clinical trial. Patients were randomized to receive either conventional autogenous block grafts or stem cell therapy. After a healing period of 4 months the treated sites were re-entered and the bone width re-assessed prior to implant placement. Implant stability was evaluated through torque testing of the implant upon insertion and at 6 months postloading. RESULTS: The mean gain in bone width was 1.5 ± 1.5 mm in the stem cell therapy group and 3.3 ± 1.4 mm in the control group. Overall, bone gain was higher in trauma patients as compared to patients with cleft palate, for both the control and the stem cell therapy groups. Most postoperative complications were wound dehiscences and incision line openings. Implants were placed successfully in 5 out of 10 patients in the stem cell therapy group and in all 8 patients in the control group. One implant from the control/cleft palate group failed before loading, while the rest of the implants were loaded successfully and remained stable at 6 months. The patients who did not receive implants were re-treated with autogenous block bone graft. CONCLUSION: The ability of stem cells to treat large alveolar defects is safe, yet, their ability to completely reconstitute large alveolar defects is limited. This approach requires further optimization to meet the outcomes seen using current methods to treat large defects, particularly those resultant of cleft palate.

[Biomaterials for bone defect repair and bone regeneration].

The treatment of large jaw bone defects remains an urgent clinical problem to be solved. With the development of biomaterials, stem cells and bone tissue engineering, new ideas and hopes for the regeneration of jaw have been offered. In addition to meeting the basic requirements of bone repair materials, scaffolds for the regeneration of large jaw bones require the ability of stem cells to participate in bone regeneration. Methods like optimization of scaffolds composition, design of porous structure and combination of gel and microsphere technology can enhance stem cell delivery in vivo, and the osteogenic differentiation of stem cells can be stimulated through controlled release of drugs, preparation of surface micron/nano topography and modifications of ionic components. Moreover, application of three-dimensional printing and channel structure in large-scale scaffolds fabrication present promising strategies for customized, accurate bone reconstruction and vascularization. It is only through synergistic optimization in all aspects that it is possible to obtain scaffold materials suitable for regeneration of large jaw bones. This article focuses on biological materials regulation, stem cell delivery, survival and differentiation, and their role in bone regeneration.

Dental and Jaw Injuries among Muay Thai Kickboxing Athletes.

Background: It has been reported globally that boxing athletes suffer a high risk of injuries, predominantly dental and jaw injuries. While the popularity of Muay Thai kickboxing is increasing in Thailand, there has been very little research evidence regarding dental and jaw injuries among Thai boxing athletes. Objective: This study aimed to evaluate the prevalence and severity, as well as factors associated with sport-related dental and jaw injuries in the northeastern Thai boxing athletes. Material and Method: A survey was conducted on 260 samples of Thai boxing athletes residing in the northeast Thailand, using both questionnaire and oral health examination. Data were analyzed using descriptive, bivariate statistics and multivariable logistic regression. Results: The results showed that 23.5% of the boxing athletes had dental and jaw injuries. Findings from the final logistic regression model revealed that weight, location of training camp (the upper part versus the lower part provinces) and location of boxing camp (rural versus urban districts) were significantly associated with dental and jaw injuries, with the adjusted odds ratios (95% CI) being 1.069 (1.040, 1.099), 2.422 (1.283, 4.571) and 4.525 (1.923, 10.638), respectively. Conclusion: The Muay Thai boxing athletes sustain substantial dental and jaw injuries, and are at subjection to impending risk of such injuries. The findings of this research may be useful for prevention and planning to reduce dental and jaw injuries among Thai boxing athletes in the future.

[CLINICAL ESTIMATION OF THE PROPHYLAXIS EFFICACY FOR POSTOPERATIVE PATHOLOGICAL CICATRICES OF FACIAL SKIN].

Efficacy of combined prophylaxis of postoperative pathological cicatrices of facial skin was studied. Application of extracorporeal shock­wave therapy and the silicone gel Strataderm have had impacted the clinical characteristics of the facial skin postoperative cicatrix positively: a shock­wave therapy promoted a sutural tracks involution, аnd the silicone gel Strataderm ­ normalization of the postoperative cicatrix pigmentation.

Intubação submento-orotraqueal: estudo retrospectivo de 2 anos / Orotraqueal submental intubation: two years retrospective study

As lesões e mortes no trânsito configuram-se como um grande problema de Saúde Pública, determinando números elevados de pacientes politraumatizados. Muitos deles apresentam injúrias severas na face, tais como as fraturas panfaciais, em que se faz necessário um procedimento cirúrgico bucomaxilofacial. Em muitos desses casos, exista a impossibilidade de manutenção da via aérea oral ou nasal. A intubação submento-orotraqueal (ISMOT) torna-se um procedimento seguro e efetivo para o manejo das vias aéreas. Este trabalho tem como objetivo realizar um estudo epidemiológico, retrospectivo dos prontuários dos pacientes atendidos no Serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital de Base de Bauru no período de janeiro de 2011 a janeiro de 2013. A prevalência da ISMOT foi de 2,36%. O gênero masculino foi o mais acometido, com 72%, e a faixa etária da terceira década de vida (42,85%). Em pacientes submetidos à ISMOT, a etiologia mais presente foram acidentes de trânsito (78,56%), sendo as fraturas de mandíbula associadas a fraturas nasais aquelas mais prevalentes (35,71%). Não foi verificada nenhuma complicação. A ISMOT é um procedimento cirúrgico importante para pacientes com fraturas severas da face, em que a intubação orotraqueal e anasotraqueal estão contraindicadas, apresentando baixa morbidez e um índice de complicações mínimo... (AU)

Injuries and traffic deaths are characterized as a major public health problem determing a large number of polytrauma patients. Many of them have severe injuries on the face, such as panfactials fractures where it is necessary an oral and maxillofacial surgical procedure. In many of these cases there is the impossibility of maintaining the oral or nasal airway. The submental intubation(ISMOT), intubation becomes a safe and effective procedure for airway management. This paper aims to performing an epidemiological retrospective of patients treated at the Surgery and Traumatology Maxillofacial the Base Hospital of Bauru from January 2011 to January 2013. The prevalence of ISMOT was 2.36 %. Male gender was the most affected, with 72 %, and the age of the third decade of life (42.85 %). In patients undergoing ISMOT, the etiology was more present traffic accidents (78.56 %), and fractures of the jaw associated with nasal fractures those most prevalent (35.71 %). There was no any complication. The ISMOT is a major surgical procedure for patients with severe fractures of the face, where oro tracheal intubation and nasotracheal intubation are contraindicated, with low morbidity and complication rate minimum... (AU)

Tratamento de fratura complexa de mandíbula por abordagem transcervical: relato de caso / Mandible complex fracture treatment through transcervical approach: case report

A fratura de mandíbula está entre as mais frequentes fraturas dos ossos da face, com um aumento significativo de casos nos últimos anos. A deficiência no exame físico e o tratamento inadequado podem levar à deformidade estética ou funcional permanente. O tratamento dessas injúrias visa efetuar uma redução anatômica e fixação dos fragmentos ósseos com o objetivo de restaurar a função e forma, reduzindo as complicações. Como opções de tratamento, incluem-se o conservador e as técnicas abertas para a redução e a fixação. O método aberto para fraturas complexas de mandíbula com múltiplos fragmentos ósseos pode ser por abordagens intraoral ou extraoral. O presente artigo relata o caso de um paciente do sexo masculino, 52 anos de idade vítima de agressão física que compareceu ao serviço de urgência de Cirurgia e Traumatologia Bucomaxilofacial apresentando trauma em face. Após o exame clínico e tomográfico, teve-se como diagnóstico a fratura múltipla de mandíbula, sendo o tratamento cirúrgico adotado com abordagem transcervical, abrangendo as regiões submandibulares bilateralmente e submentoniana com simplificação dos fragmentos com placas do sistema 2.0mm e fixação com placa do sistema 2.4mm, do tipo locking. O paciente segue em acompanhamento pós-operatório de seis meses sem queixas estéticas e funcionais... (AU)

The mandible fracture is among the most common of the bones of the face, with a significant increase in cases in recent years. Deficiency in physical examination and inadequate treatment can lead to aestheticor permanent functional deformity. The treatment of these injuries aims to make an anatomic reduction and fixation of bone fragments in order to restore form and function, reducing complications. The treatment options include conservative and open techniques for reduction and fixation. The open method for complex fractures of the jaw with multiple bone fragments can be through intra-oral or extra-oral approaches. This article reports a case of a male patient, 52 years old, physical aggression victim, who attended the urgency department of Oral and Maxillofacial Surgerywith trauma in the face. After clinical and CT examination had up to diagnosis of multiple jaw fractures, and surgical treatment with transcervical approach covering bilateral submandibulars and submental regions with simplification of the fragments with 2.0mm system plates and fixation with2.4mm system plates, locking type. The patient follows in postoperative follow-up of six months without aesthetic and functional complaints... (AU)

Levantamento epidemiológico das fraturas faciais no Hospital Regional de Urgência e Emergência de Presidente Dutra - MA / Epidemiological survey of facial fractures in the Hospital Regional of Urgency and Emergency of President Dutra - MA

Objetivo: este trabalho tem por finalidade determinar a prevalência das Fraturas Faciais, tratadas no Hospital Regional de Urgência e Emergência de Presidente Dutra; Assim classificando-o em gênero, faixa etária, localizações anatômicas mais atingidas e fator etiológico. Foi realizada uma análise epidemiológica das informações contidas nos prontuários dos 552 pacientes que foram atendidos pela equipe de Cirurgia e Traumatologia Buco-maxilo-facial no Hospital Regional de Urgência e Emergência de Presidente Dutra, na cidade de Presidente Dutra-Maranhão. Desses foi observada uma maior ocorrência no gênero masculino com 456 (82%), e a faixa etária mais acometida foi de 21 a 30 anos com 231 (42%), que pode ser atribuída ao maior acesso dos jovens à motocicleta, sendo o fator etiológico mais prevalente com 309 (62%), e a região mais atingida foi mandíbula e zigomático, com 177 (33%) e 146 (27%) respectivamente. Constataram-se, por meio dos dados, que os jovens do sexo masculino são os mais atingidos, e a motocicleta, o maior fator causal. Assim os dados sugerem um alerta aos órgãos públicos e à população, uma maior fiscalização e conscientização dos motociclistas quanto ao risco de acidentes e possíveis consequências... (AU)

This study aims to determine the prevalence of Facial Fractures treated in the Regional Hospital Emergency and Emergency Presidente Dutra. So classifying it in gender, age, most affected anatomical locations and etiology. An epidemiological analysis of the information contained in the medical records of 552 patients who were treated by the staff of Surgery and Traumatology Oral and maxillofacial at Regional Hospital Emergency and Emergency Presidente Dutra, in the city of Presidente Dutra-Maranhão was performed. These were observed a higher occurrence in males with 456 (83%) and the most affected age group was 21-30 years, with 231 (42%), which can be attributed to greater access for young motorcycle, which was the factor etiological more prevalent with 309 (62%), and the most affected region was jaw and zygomatic, with 177 (33%) and 146 (27%) respectively. It is found from the data that the young men are the most affected and the largest motorcycle causal factor, therefore the data suggest a warning to public agencies and the public greater oversight and awareness of motorcyclists on the inherent risk of accidents and possible consequences... (AU)

Guided implant surgery after free-flap reconstruction: Four-year results from a prospective clinical trial.

AIM: The aim of this prospective clinical study is to assess the 4-year outcomes of implant-supported restorations performed using a computer-guided template-assisted flapless implant surgery approach in patients reconstructed with fibula or iliac crest free flaps. MATERIALS AND METHODS: Twelve jaws in 10 patients were reconstructed with osteomyocutaneous free flap after tumour resection or gunshot wound, after complete healing computer-assisted template-based flapless implant placement, based on prosthetic and aesthetic analysis, was performed using a customized protocol. Treatment success was evaluated using the following parameters: survival of implants/prostheses, prosthetic and biologic complications, marginal bone remodelling, soft tissue parameters and patient satisfaction. RESULTS: A total of 56 implants were placed; the implants ranged between 8 and 16 mm in length and were either 3.5, 4.3 or 5 mm wide. All the patients have reached the 4-year follow-up. Three implants were lost accounting for an overall implant survival rate of 94.6%. No prosthesis were lost. Some complications were recorded. Four years after loading the mean marginal bone loss was 1.43 ± 0.49 mm at the palatal/lingual site and 1.48 ± 0.46 mm at the vestibular site. All the patients showed healthy soft tissues with stable probing depth (4 .93 ± 0.75%) and successful bleeding on probing values (12 ± 5.8%); 90% of patients were satisfied of the treatment at the 4-year follow-up. CONCLUSIONS: Computer-guided template-assisted flapless implant surgery seems to be a viable option for patients undergoing reconstruction with free flaps after tumour resection or gunshot trauma, although many challenges remain. A high degree of patient satisfactorily was reported.

Implant-Supported Telescopic Crown-Retained Overdentures for Oral Rehabilitation of Patients with Severe Bony Defects: A 5-Year Retrospective Study.

PURPOSE: To evaluate the performance of dental implant-supported telescopic crown (TC)-retained overdentures to restore the oral function of patients who have insufficient jawbone volume resulting from tumor resection or trauma. MATERIALS AND METHODS: From January 2004 to December 2008, implant-supported TC-retained overdentures were used to restore the oral function of patients with severe bony defects resulting from tumor resection or trauma. Clinical data, including implant success and survival rates, biologic and mechanical complications, prosthodontic maintenance efforts, and patient satisfaction, were analyzed annually after delivery of the final prostheses. RESULTS: Twenty-four patients were treated, and a total of 88 implants were inserted to support TC-retained overdentures. The mean modified plaque index of implants remained low (<20%), and the majority of implants (>76.3%) in the study showed the absence of bleeding on probing at follow-up visits. Peri-implant marginal bone loss (MBL) ranged from 0.8 to 1.2 mm. There was no statistically significant difference in the MBL between maxillary and mandibular implants (P = .43). The implant success rate was 100% after 5 years, and the prosthodontic maintenance and complication rate was 0.22 times per year. More than 90% of patients were satisfied with the restoration of their oral function using TCs. CONCLUSION: Based on our study of 24 patients treated with TC-retained overdentures, it appears that this treatment may be a viable option for patients with insufficient jawbone volume.

Dental and jaw injuries sustained by hooligans.

AIM: The study deals with fighting-related dental injuries sustained by hooligans and the influence of wearing a mouthguard on fighting-related dental trauma. MATERIAL AND METHODS: From 2012 to 2013, standardized multiple-choice questionnaires were distributed via contacts in the hooligan scene in Switzerland. The survey was conducted with the guarantee of complete anonymity and investigated injury patterns in hooligans from different age groups, of different nationalities as well as educational and income levels. RESULTS: Of the 95 hooligans surveyed, 82 had sustained a dental injury: 29 were minor and 53 were severe dental injuries. During violent confrontations, 37 of the 95 hooligans wore a mouthguard. The most commonly used mouthguards were custom-made (19/37) or boil-and-bite (10/37). The use of ready-made mouthguards without an individualized fit (6/37) was less frequent. Hooligans who wore a boil-and-bite or a custom-made mouthguard lost fewer teeth during fights than participants wearing a mouthguard without an individualized fit (P = 0.056). CONCLUSION: The risk of trauma during violent confrontations between hooligans is very high, as expected. The injuries range from dental trauma to bruising, lacerations and even serious bone fractures of the face and the extremities. During violent clashes over a third of the hooligans wear a mouthguard that has usually been custom-made or at least individually fitted; this is a far higher frequency than for most contact sports.

[Tissue engineering in dentistry].

Possibility of using stem cells and developing tissue engineering for regeneration of jaws bone defects, bones vault of the skull, dental and periodontal tissue are presented in the article.

British dental surgery and the First World War: the treatment of facial and jaw injuries from the battlefield to the home front.

When Britain went to war in 1914, the British Expeditionary Force was deployed without a single dentist. Initially considered combatants, the only dental professionals who could serve at the Front were medically qualified dental surgeons in the Royal Army Medical Corps. In treating the traumatic facial and jaw injuries caused by trench warfare, the dental surgeons of this era earned their place on specialist surgical teams and established the principles of oral and maxillofacial surgery. This article will examine the contribution of specialist dental surgeons to the management of facial and jaw wounds in the First World War along the chain of evacuation from the battlefield to the home front, using illustrative examples from the Hunterian Museum at the Royal College of Surgeons of England.