RESUMO
BACKGROUND: This systematic review aimed to incorporate published data regarding synchronous cemento-ossifying fibromas (COF), with an analysis of their demographic and clinicopathological characteristics. MATERIAL AND METHODS: Case reports and case series of synchronous COF were searched in PubMed, Web of Science, Scopus, EMBASE, and LILACS according to the PRISMA (2020) statement. Also, a manual search was carried out and the grey literature was assessed. A descriptive statistical analysis was performed. RESULTS: Nineteen studies comprising 20 cases of synchronous COF were included. The mean age at diagnosis was 35 years (±13.8), with a predominance of female patients (n=12/60%). In 13 cases (65%) the mandible and the maxilla were affected simultaneously. In two cases (10%) first-degree relatives (parents or siblings) had been previously diagnosed with COF. The diagnostic hypotheses were reported in 8 cases (40%), with florid cemento-osseous dysplasia, ameloblastic fibroodontoma, calcifying cystic odontogenic tumor, osteoma and cementoblastoma being cited in the differential diagnosis. Among the cases with details about management (n=17), eleven were treated by surgical enucleation and/or excision (64.7%). Follow-up was provided for 10 cases (50%), with a mean period of 44.7±62.19 months. Recurrence occurred in three of informed cases. CONCLUSIONS: Synchronous manifestation of COF is rare. Female patients around the 3rd decade of life are more commonly affected. Bilateral involvement of the mandible and maxilla is the most common clinical presentation.
Assuntos
Fibroma Ossificante , Humanos , Fibroma Ossificante/patologia , Fibroma Ossificante/diagnóstico , Feminino , Neoplasias Primárias Múltiplas/patologia , Neoplasias Mandibulares/patologia , Cementoma/patologia , Adulto , Masculino , Neoplasias Maxilares/patologiaRESUMO
Adenoid ameloblastoma is a newly recognized epithelial odontogenic tumor. Herein, we present the case of a 24-year-old male patient who exhibited swelling in the anterior region and right hemi-mandible. Computed tomography demonstrated the presence of a hypodense osteolytic lesion associated with an impacted tooth. Based on the clinical hypotheses of the dentigerous cyst, odontogenic keratocyst, and ameloblastoma, an incisional biopsy was performed, and the diagnosis of ameloblastoma was rendered. A surgical resection of the tumor was performed. Histopathological examination of the specimen revealed typical areas of ameloblastoma associated with ductiform structures and cell proliferation in a solid storiform pattern, features resembling those found in adenomatoid odontogenic tumor. Based on these findings, the diagnosis of adenoid ameloblastoma was rendered. The accurate diagnosis of this locally infiltrative tumor is essential due to its similarity to other odontogenic neoplasms.
Assuntos
Ameloblastoma , Neoplasias Mandibulares , Humanos , Masculino , Ameloblastoma/patologia , Adulto Jovem , Neoplasias Mandibulares/patologia , Tumores Odontogênicos/patologiaRESUMO
Objetivo: Presentar un caso clínico de un tumor odon- togénico epitelial calcificante (TOEC), así como una revisión de la literatura disponible sobre esta neoplasia para contribuir al análisis del mejor método de tratamiento de la patología. Caso clínico: Se presenta el caso de una paciente mujer de 35 años con un tumor odontogénico epitelial calcifican- te que recibió tratamiento de enucleación quirúrgica con una evolución favorable y seguimiento de 5 años por medio de evaluación clínica y radiológica. La elección terapéutica se basó en el resultado de un análisis exhaustivo de la literatura para determinar el mejor abordaje de la neoplasia (AU)
Aim: To present a clinical case of a calcifying epithelial odontogenic tumor (CEOT), as well as a review of the availa- ble literature on this neoplasia to contribute to the analysis of the best treatment method for the pathology. Clinical case: The case of a 35-year-old patient with a calcifying epithelial odontogenic tumor who received surgical enucleation treatment with a favorable evolution and 5-year follow-up through clinical and radiological evaluation is pre- sented. The therapeutic choice was based on the result of an exhaustive analysis of the literature to determine the best ap- proach to the neoplasia (AU))
Assuntos
Humanos , Feminino , Adulto , Neoplasias Mandibulares/cirurgia , Tumores Odontogênicos/classificação , Procedimentos Cirúrgicos Bucais/métodos , Biópsia/métodos , Tumores Odontogênicos/diagnóstico por imagem , SeguimentosRESUMO
El fibroma ameloblástico (FA) se describe como una neoplasia benigna de origen odontogénico mixto que suele presentarse entre la primera y segunda década de vida, frecuentemente en los molares permanentes inferiores. Por lo general es asintomático, pero las lesiones de gran tamaño suelen acompañarse con dolor e inflamación. Su tratamiento por lo regular es conservador. Se describe el caso de un fibroma ameloblástico en un paciente de 13 años de edad, que involucraba cuerpo y ángulo mandibular izquierdo, tratado de manera conservadora, se realiza extirpación del tumor, regeneración ósea guiada y rehabilitación con implante dental (AU)
Ameloblastic fibroma (AF) is described as a benign neoplasm of mixed odontogenic origin that usually presents between the first and second decade of life, frequently in lower permanent molars. It is usually asymptomatic, but large lesions are usually accompanied by pain and inflammation. His treatment is generally conservative. The clinical case of an ameloblastic fibroma in a 13-year-old patient is described, involving the left mandibular body and angle, treated conservatively, tumor removal, guided bone regeneration and rehabilitation with dental implants are performed (AU)
Assuntos
Humanos , Masculino , Adolescente , Regeneração Óssea , Neoplasias Mandibulares/cirurgia , Tumores Odontogênicos/classificação , Fibroma/cirurgia , Prognóstico , Implantação Dentária Endóssea/métodos , Diagnóstico Diferencial , Fibroma/reabilitaçãoRESUMO
BACKGROUND: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. MATERIAL AND METHODS: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. RESULTS: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. CONCLUSIONS: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure.
Assuntos
Neoplasias Mandibulares , Qualidade de Vida , Humanos , Mandíbula/cirurgia , Nervo Mandibular/cirurgia , Extração Dentária/métodosRESUMO
Objetivo: O objetivo deste estudo foi relatar o caso clínico de uma paciente do sexo feminino, 40 anos, feoderma, ASA I, com lesão nodular na região papilar entre os elementos incisivo lateral e canino inferiores apresentando características de base séssil, sólida e fibrosa. Materiais e Métodos: Foi realizada uma biópsia excisional da lesão, e a peça cirúrgica foi coletada em um recipiente contendo formol 10% para exame histopatológico e confirmação para o diagnóstico de fibroma. Resultados: O exame histopatológico confirmou o diagnóstico de fibroma. No pós-operatório, a região cirúrgica foi de início acompanhada semanalmente e, posteriormente, em intervalos mensais a partir da quarta semana, com prognóstico favorável. Conclusão: O diagnóstico preciso do fibroma é fundamental para garantir o melhor tratamento possível. Este caso clínico destaca a importância da biópsia excecional e do acompanhamento pós-operatório adequado para assegurar uma recuperação satisfatória do paciente.(AU)
Objective: The objective of this study was to report a clinical case of a 40-year-old female patient with a nodular lesion in the papillary region between elements lower lateral incisor and canine presenting features of a sessile, solid, and fibrous base. Materials and Methods: An excisional biopsy of the lesion was performed, and the surgical specimen was collected in a container containing 10% formalin for histopathological examination and confirmation of the fibroma diagnosis. Results: The histopathological examination confirmed the diagnosis of fibroma. In the postoperative period, the surgical region was initially monitored weekly and subsequently at monthly intervals from the fourth week, with a favorable prognosis. Conclusion: Accurate diagnosis of fibroma is essential to ensure the best possible treatment. This clinical case highlights the importance of excisional biopsy and appropriate postoperative follow-up to ensure a satisfactory patient recovery.(AU)
Assuntos
Humanos , Feminino , Adulto , Neoplasias Mandibulares/cirurgia , Fibroma/cirurgia , Biópsia , Neoplasias Mandibulares/patologia , Resultado do Tratamento , Fibroma/patologiaRESUMO
Ameloblastoma is a benign locally aggressive odontogenic tumor of epithelial origin with unlimited growth capacity. Cervical lymphoepithelial cyst is a developmental cyst located in the superior-lateral region of the neck with treatment consisting of surgical excision, which presents low recurrence rates. This article reports the case of patient J.G.S.L., 24 years old, female, who reported to the service with a histopathological evaluation compatible with intraosseous mandibular ameloblastoma. On physical examination, a nontender swelling was palpable along the body of left mandible where the ameloblastoma was located, with a fluctuant region detected just below it. Imaging exams confirmed the suspicion of two independent lesions. The treatment plan consisted of two stages: first, mandibular resection of the area affected by the ameloblastoma, followed by reconstruction with a titanium plate simultaneous to excisional biopsy of the as yet undiagnosed lesion, both through intraoral access; second, mandibular reconstruction with iliac crest graft. Histopathological examination of the second lesion indicated a diagnosis of cervical lymphoepithelial cyst, being the first case in the literature with these concomitant lesions. Currently, the patient is in her third postoperative year with no signs of recurrence.
Assuntos
Ameloblastoma , Cistos , Neoplasias Mandibulares , Tumores Odontogênicos , Humanos , Feminino , Adulto Jovem , Adulto , Ameloblastoma/diagnóstico por imagem , Ameloblastoma/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia , Mandíbula/cirurgia , Tumores Odontogênicos/cirurgiaRESUMO
Neoplastic masses were evaluated in the rostral region of the mandible of three young adult cattle. In all three cases, the masses were macroscopically large, firm, ulcerated, infiltrative, whitish and solid, and led to tooth displacement and loss. Radiographically, the neoplastic masses were intraosseous and radiolucent with foci of radiopacity. Loss of radiopacity due to bone necrosis was seen in the mandibular bone adjacent to the neoplasms. Histologically, well-differentiated, infiltrative non-encapsulated mesenchymal neoplastic proliferation replaced the mandibular bone and extended to the oral mucosa in all three cases. The neoplastic cells had scant cytoplasm and fusiform or oval hyperchromatic nuclei with loose chromatin, and were arranged in bundles in various directions. Within the neoplastic tissue, there were mineralized bone trabeculae and unmineralized osteoid, lined by a layer of osteoblasts and osteocytes within the lacunae. The pre-existing bone tissue adjacent to the neoplasm had areas of necrosis and osteoclasis of variable extent and intensity. Based on the macroscopic, radiographic and microscopic findings, a diagnosis of mandibular ossifying fibroma was established in all three cattle.
Assuntos
Doenças dos Bovinos , Fibroma Ossificante , Neoplasias Mandibulares , Neoplasias de Tecidos Moles , Animais , Bovinos , Doenças dos Bovinos/diagnóstico por imagem , Cromatina , Fibroma Ossificante/veterinária , Mandíbula/patologia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/veterinária , Neoplasias de Tecidos Moles/veterináriaRESUMO
O fibroma ossificante juvenil trabecular (FOJTr) é uma lesão fibro-óssea benigna rara de comportamento agressivo, alto potencial de recorrência, e acometimento no esqueleto craniofacial de crianças e adolescentes. Uma paciente do gênero feminino, 8 anos de idade, compareceu ao ambulatório de Patologia Oral e Maxilofacial da Universidade de Gurupi UNIRG para avaliação clínica de um aumento de volume na região de corpo da mandíbula do lado esquerdo. Não havia sintomatologia dolorosa e sequer desconforto. Nos exames de imagem (radiografia panorâmica e tomografia computadorizada) foram observados uma extensa área radiolúcida que se estendia desde o primeiro molar permanente com rizogênese incompleta até o incisivo central do lado oposto. Após a realização da biópsia incisional e laudos histopatológicos realizou-se a remoção completa da lesão incluindo os remanescentes decíduos sobrejacentes ao fibroma. Nas imagens de controle pós-operatório aos 90 dias (radiografia panorâmica e tomografia computadorizada), notou-se sinais de neoformação óssea com espessamento basilar e os germes dos dentes permanentes em franco desenvolvimento. Diante disso, ressalta-se a importância do conhecimento dos aspectos clínicos, radiográficos e histopatológicos para a realização de um correto diagnóstico e tratamento adequado afim de reduzir as altas taxas de recidivas... (AU)
Trabecular juvenile ossifying fibroma (TrJOF) is a rare benign fibro-osseous lesion, with aggressive behavior, high recurrence potential, which affects the craniofacial skeleton of children and adolescents. This paper aims to describe a clinical case in a female patient, 8 years old, who attended the Oral and Maxillofacial Pathology outpatient clinic Faculty of Dentistry University of Gurupi - UNIRG, city of Gurupi - TOCANTINS - BRAZIL for clinical evaluation of an increased in volume in the region of the mandible body, on the left side. There was no painful symptomatology or even discomfort. Imaging examinations (panoramic radiography and computed tomography (CT) showed an extensive radiolucent area that extended from the first permanent molar with incomplete root formation to the central incisor on the opposite side. After performing an incisional biopsy and histopathological examination, the lesion was completely removed included the remainder deciduous teeth overlying the tumor. In the postoperative control images at 90 days (panoramic radiography and CT), signs of bone neoformation with basilar thickening and the germs of the permanent teeth in full development were noted. In view, this importance of knowledge of clinical, radiographic and histopathological aspects is emphasized for the realization of a correct diagnosis and adequate treatment in order to reduce the high rates of relapses... (AU)
El fibroma osificante trabecular juvenil (TRFOJ) es una lesión fibroósea benigna rara con comportamiento agresivo, alto potencial de recurrencia y afectación del esqueleto craneofacial de niños y adolescentes. Paciente femenina de 8 años de edad que acude al ambulatorio de Patología Oral y Maxilofacial de la Universidad de Gurupi - UNIRG para evaluación clínica de aumento de volumen en la región del cuerpo mandibular del lado izquierdo. No presentaba sintomatología dolorosa ni molestias. Los exámenes de imagen (radiografía panorámica y tomografía computarizada) mostraron una extensa área radiolúcida que se extendía desde el primer molar permanente con formación radicular incompleta hasta el incisivo central del lado opuesto. Tras realizar la biopsia incisional y los informes histopatológicos, se procedió a la extirpación total de la lesión, incluidos los remanentes caducos que recubrían el fibroma. En las imágenes de control postoperatorio a los 90 días (radiografía panorámica y tomografía computarizada), se observaron signos de neoformación ósea con engrosamiento basilar y los gérmenes de los dientes permanentes en pleno desarrollo. Por tanto, es importante conocer los aspectos clínicos, radiográficos e histopatológicos para la realización de un diagnóstico correcto y un tratamiento adecuado con el fin de reducir las altas tasas de recaídas... (AU)
Assuntos
Humanos , Feminino , Criança , Neoplasias Ósseas/diagnóstico , Fibroma Ossificante/diagnóstico , Osso Esponjoso/patologia , Biópsia , Radiografia Panorâmica , Neoplasias Mandibulares/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
El ameloblastoma es un tumor odontogénico agresivo que se clasifica en uniquístico, extraóseo/periférico y metastatizante. Una mujer de 42 años acudió al Servicio de Cirugía Oral y Maxilofacial por aumento de volumen hemifacial izquierdo de 6 meses de evolución. Al examen se observó aumento de volumen de la región parotídea y submandibular izquierda, abombamiento tablas óseas mandibulares y movilidad dental. La tomografía axial computarizada reveló una lesión de aspecto quístico en la región mandibular. Se realizó la biopsia incisional y el tratamiento quirúrgico conservador. El diagnóstico histopatológico fue ameloblastoma uniquístico patrón mural. Luego de seis meses de descompresión, se realizó una nueva biopsia incisional, curetaje óseo y se aplicó solución de Carnoy. Once meses posteriores a la primera intervención, se constató radiográficamente aposición ósea de la lesión. El tratamiento de estos ameloblastomas continúa siendo controversial por lo que cada caso se debe abordar de manera única.
Ameloblastoma is an aggressive odontogenic tumor classified as unicystic, extraosseous / peripheral, and metastasizing. A 42-year-old woman was attended at the Oral and Maxillofacial Surgery Service due to a 6-month facial asymmetry. Clinically, we observed a volume increase of the left parotid and submandibular region, bulging of the mandibular bone tables and dental mobility. Computed Tomography revealed a cystic-like lesion in the mandibular region. An incisional biopsy and conservative surgical treatment were performed. The histopathological diagnosis was unicystic ameloblastoma, mural pattern. After six months of decompression, a new incisional biopsy and bone curettage were performed, and Carnoy's solution was applied. Eleven months after the first intervention, bone apposition was observed in the x-ray. The treatment of these ameloblastomas continues to be controversial, so every case should be approached in a unique manner.
Assuntos
Humanos , Feminino , Adulto , Ameloblastoma/cirurgia , Ameloblastoma/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Radiografia Panorâmica , Ameloblastoma/patologia , Neoplasias Mandibulares/patologia , Cistos Odontogênicos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandible. The etiology is still unknown, and the hypothesis of its development is debated. CASE PRESENTATION: A 35-year-old Caucasian man presenting a tumor lesion in the right jawbone that had been growing for 8 years sought medical service complaining of speaking impairment. According to the patient, the tumor appeared shortly after a minor trauma caused by tooth extraction. The diagnosis of the lesion was made through clinical, radiographic, and histological methods, and the surgical treatment was successful and satisfactory for the patient as well as the surgical team, despite a short follow-up. CONCLUSION: Etiopathogenesis of osteoma is not determined in the majority of cases. In the present report, it was possible to hypothesize the association between a minor trauma and the development of the tumor, reinforcing the reactive theory of tumor development. The uncommon location of the osteoma, as well the possibility of identifying the possible cause of the lesion, makes this case particularly interesting.
Assuntos
Neoplasias Mandibulares , Osteoma , Adulto , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia , Anamnese , Osteoma/diagnóstico por imagem , Osteoma/cirurgia , Extração DentáriaRESUMO
Clear cell odontogenic carcinoma (CCOC) is a rare malignant odontogenic tumor. It is characterized by showing, on histopathological examination, clusters of vacuolated and clear tumor cells with epithelial differentiation surrounded by fibrocollagenous stroma and fibroblasts. The present study presents a rare clinical case of mandibular CCOC associated with an impacted tooth in a 26-year-old woman surgically treated with mandibulectomy and reconstruction with iliac crest bone graft. The patient has been followed up for 22 months without signs of recurrence. A search for case report/case series was carried out in the PUBMED database, as well as in the references of relevant previously published literature reviews. Ninety-six publications were identified, totaling 136 distinct cases reported. Female sex was the most affected (63.1%) with 63.3% of cases occurring in patients in the fifth, sixth, or seventh decades of life. The mandible was more affected than the maxilla (74.2%). Association of CCOC with impacted teeth was found in 2.4% of cases, thus rendering it a rare occurrence. The present case report corroborates the results of the survey regarding sex and anatomical location of the tumor; however, it contradicts the findings regarding age predilection. The case described is the fourth known occurrence of tooth impaction associated with the tumor and the first in a female. In conclusion, CCOC should be considered, as well as other malignancies, as a possible diagnosis of maxillary or mandibular intraosseous lesions even in unusual circumstances such as in association with impacted teeth and in young patients.
Assuntos
Carcinoma , Neoplasias Mandibulares , Tumores Odontogênicos , Dente Impactado , Adulto , Feminino , Humanos , Neoplasias Mandibulares/diagnóstico , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/cirurgia , Osteotomia Mandibular/métodos , Tumores Odontogênicos/diagnóstico , Tumores Odontogênicos/cirurgia , Dente Impactado/diagnóstico por imagem , Dente Impactado/patologia , Dente Impactado/cirurgiaRESUMO
Proper management of the airway as anesthesiologists is essential to avoid respiratory complications and the development of new technologies has allowed every day the possibility of a safer anesthetic management, this is how ultrasound has had great relevance today, since it allows perform increasingly safe and effective procedures, allowing the detection of anatomical altera- tions that together with clinical measurements give us predictability of the difficult airway, since it allows us to identify thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilage and esophagus. The clinical case of a male is presented in which multiple predictors of difficult airway are reported, due to the presence of a malignant tumor in the left mandibular body scheduled for surgical resection, in whom an evaluation of the anatomical structures was performed to rule out airway malformations with ultrasound visualization with the use of a high frequency linear transducer configured for superficial tissues in axial approach, later in real time it was used to corroborate successful intubation; Therefore, the use of ultrasound allows a more efficient management to be carried out in the approach of the difficult airway in this patient, which confirms the usefulness of this method as described in the consulted literature.
El manejo adecuado de la vía aérea como anestesiólogos es fundamental para evitar complicaciones respiratorias, y el desarrollo de nuevas tecnologías ha permitido cada día la posibilidad de un manejo anestésico más seguro. Es así como el ultrasonido ha tenido gran relevancia en la actualidad, ya que permite realizar procedimientos cada vez más seguros y efectivos, permitiendo detectar alteraciones anatómicas que, junto con mediciones clínicas, nos otorga predictibilidad de la vía aérea difícil, dado que nos permite identificar cartílago tiroideo, epiglotis, cartílago cricoides, membrana cricotiroidea, cartílagos traqueales y esófago. Se expone el caso clínico de un masculino en que se reportan múltiples predictores de vía aérea difícil, por la presencia de tumor maligno en cuerpo mandibular izquierdo, programado para resección quirúrgica, en quien se realizó evaluación de las estructuras anatómicas para descartar malformaciones de la vía aérea con visualización ecográfica con el uso de transductor lineal de alta frecuencia, configurado para tejidos superficiales en abordaje axial. Posteriormente, en tiempo real, se utilizado para corroborar intubación exitosa; por lo cual el uso de ultrasonido permite ejecutar un manejo más eficaz en el abordaje de la vía aérea difícil en este paciente, lo cual confirma la utilidad de este método como se describe en la literatura consultada.
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Neoplasias Mandibulares/complicações , Ultrassonografia/métodos , Manuseio das Vias Aéreas/métodos , Intubação Intratraqueal/métodos , Anestesia , Cuidados Pré-Operatórios , Neoplasias Mandibulares/cirurgia , Esôfago/diagnóstico por imagem , Complicações Intraoperatórias/prevenção & controle , Cartilagens Laríngeas/diagnóstico por imagemRESUMO
BACKGROUND: The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction. CASE PRESENTATION: We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. CONCLUSIONS: The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.
Assuntos
Implantes Dentários , Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Procedimentos de Cirurgia Plástica , Adulto , Transplante Ósseo , Feminino , Fíbula/cirurgia , Seguimentos , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgiaRESUMO
Osteochondroma is a common benign bone tumor and although its involvement in facial bones is rare (0.6 %), it shows a strong predilection for developing in the mandibular condyle, causing occlusal changes and facial asymmetry. The aim of this study was to report a clinical case and the treatment of a 43-year-old male patient, who was diagnosed with condylar osteochondroma. Clinically, the patient presented an increase in volume in the right condylar region, deviation of the mandible to the left side and malocclusion. His main complaint was his facial asymmetry. Imaging exams showed changes in the size and morphology of the right condyle, and signs of hyper-capture on scintigraphy. The hypothesis of condylar hyperplasia and osteochondroma was raised. A virtual planning and execution of an orthognathic surgery of the jaws was performed to correct the occlusion and facial asymmetry, besides a low condylectomy to remove the lesion. Procedures such as high, low, proportional condylectomy, orthognathic surgery and TMJ reconstructive surgery are alternatives for the treatment of these pathologies. In our case, the orthognathic surgery combined with a condylectomy proved to be promising, to correct the occlusion and the facial asymmetry of the patient.
El osteocondroma es un tumor óseo benigno común y aunque su afectación en los huesos faciales es rara (0,6 %), muestra una fuerte predilección por desarrollarse en el cóndilo mandibular, causando cambios oclusales y asimetría facial. El objetivo de este trabajo fue informar de un caso clínico y el tratamiento de un paciente de sexo masculino de 43 años, que fue diagnosticado con osteocondroma cóndilar. Clínicamente, el paciente presentaba un aumento en el volumen en la región condilar derecha, desviación de la mandíbula hacia el lado izquierdo y maloclusión. Su principal molestia era su asimetría facial. Los exámenes por imágenes mostraron cambios en el tamaño y la morfología del cóndilo derecho, y signos de hiper-captura en la centellografía. Se planteó la hipótesis de hiperplasia condilar y osteocondroma. Se realizó una planificación virtual y ejecución de una cirugía ortognática de la mandíbula para corregir la oclusión y la asimetría facial, además de una baja condilectomía para extirpar la lesión. Procedimientos como la condilectomía alta, baja y proporcional, la cirugía ortognática y la cirugía reconstructiva de la ATM son alternativas para el tratamiento de estas patologías. En nuestro caso, la combinación de la cirugía ortognática y una condiloectomía resultó ser prometedora, para corregir la oclusión y la asimetría facial del paciente.
Assuntos
Humanos , Masculino , Adulto , Neoplasias Mandibulares/cirurgia , Osteocondroma/cirurgia , Côndilo Mandibular/cirurgia , Radiografia Panorâmica , Seguimentos , Imageamento Tridimensional , Assimetria Facial , Procedimentos Cirúrgicos Ortognáticos/métodos , Cirurgia Ortognática/métodos , Côndilo Mandibular/patologiaRESUMO
RESUMEN Se presentó el caso de una paciente femenina de 40 años de edad que acudió a consulta por presentar aumento de volumen en la región parotídea izquierda. Se realizó ortopantomografía, radiografías simples anteroposterior y lateral de cráneo que revelaron la presencia de una imagen radiolúcida en la región lateral de la rama mandibular izquierda. El diagnóstico clínico fue de osteoma periférico a este nivel, por lo que se realizó remoción quirúrgica total de la lesión. La biopsia confirmó el diagnóstico de osteoma ebúrneo periférico. El osteoma es una neoplasia benigna de tejido óseo, poco frecuente y, rara vez, se localiza de manera aislada en la mandíbula. No se diagnosticaron complicaciones posoperatorias y la paciente mostró satisfacción con la atención estomatológica brindada.
ABSTRACT A 40-year-old female patient came to the consultation due to an increase in volume in the left parotid region. Orthopantomography and simple anteroposterior and lateral skull radiographies were performed, revealing the presence of a radiolucent image in the lateral region of the left mandibular side. The clinical diagnosis at this point was of peripheral osteoma, for which a total surgical removal of the lesion was performed. The biopsy confirmed the diagnosis of peripheral osteoma. An osteoma is a rare benign neoplasm of bone tissue, and is rarely found isolated in the mandible. Postoperative complications were not diagnosed and the patient was satisfied with the dental care provided.
RESUMO Foi apresentado o caso de uma paciente do sexo feminino, 40 anos de idade, que compareceu à consulta por aumento de volume na região da parótida esquerda. Foram realizadas ortopantomografia, radiografias simples ântero-posterior e lateral do crânio, que revelaram a presença de imagem radiotransparente na região lateral do ramo mandibular esquerdo. O diagnóstico clínico foi de osteoma periférico a este nível, para o qual foi realizada a remoção cirúrgica total da lesão. A biópsia confirmou o diagnóstico de osteoma periférico ebúrneo. O osteoma é uma neoplasia benigna do tecido ósseo, pouco frequente e raramente localizada de forma isolada na mandíbula. Complicações pós-operatórias não foram diagnosticadas e o paciente ficou satisfeito com o atendimento odontológico prestado.
Assuntos
Humanos , Feminino , Adulto , Osteoma/cirurgia , Osteoma/diagnóstico por imagem , Mandíbula/patologia , Ritidoplastia/métodos , Neoplasias MandibularesRESUMO
Objective: the present report describes the clinical, radiographic, and histopathological features of an ameloblastic fibro-odontoma (AFO) lesion. Case report: we report a clinical case of a 14-year-old boy with asymptomatic edema. Panoramic radiography detected a unilocular lesion with defined margins located in the posterior region of the mandible. The internal structure of the lesion presented several degrees of radiopacity with the involvement of the third molar. Cone-beam computed tomography revealed expanded buccal and lingual cortical bones, perforation of the lingual cortical bone, and displacement of the mandibular canal. AFO was suspected based on the radiographic and clinical characteristics. Total excision was performed and histologically examined, confirming the diagnosis of AFO. No recurrence occurred during a 24-month follow-up period. Final considerations: the evaluation of the clinical, radiographic, and histopathologic findings needs to be accurate for a correct diagnosis and appropriate treatment for case of AFO since the presentation is often asymptomatic.(AU)
Objetivo: o presente relato descreve as características clínicas, radiográficas e histopatológicas de uma lesão de fibro-odontoma ameloblástico (FOA). Relato de caso: relatamos o caso clínico de um menino de 14 anos com edema assintomático. A radiografia panorâmica detectou lesão unilocular com margens definidas e localizada na região posterior da mandíbula. A estrutura interna da lesão apresentava vários graus de radiopacidade com envolvimento do terceiro molar. A tomografia computadorizada de feixe cônico revelou as corticais ósseas vestibular e lingual expandidas, perfuração da cortical óssea lingual e deslocamento do canal mandibular. FOA foi a hipótese diagnóstica com base nas características radiográficas e clínicas. A excisão total foi realizada e examinada histologicamente, confirmando o diagnóstico de FOA. Nenhuma recorrência ocorreu durante um período de acompanhamento de 24 meses. Considerações finais: a avaliação das características clínicas, radiográficas e histopatológicas contribuíram para um diagnóstico correto e o tratamento adequado para o caso de FOA, uma vez que a lesão é frequentemente assintomática.(AU)