Quality of Life and Maxillary Defects: A Cross-Sectional Study / Calidad de Vida y Defectos Maxilares: Un Estudio Transversal

ABSTRACT: There has been little discussion about the quality of life of patients with maxillary defects. This article evaluates the issues related to the condition. We performed a cross-sectional study of patients with maxillary defects from referral centers in Brazil. To avoid subject burden, a questionnaire was developed, based on questions from seven instruments, which dealt with domains and conclusions that were similar to those from other studies. The predictor variable was the patients' score for each question. The outcome measure was the presence of the best-ranked items on the questionnaire as the impact factor. Six experts assessed these items and suggested which questions to include or exclude. Patients scored each item according to its occurrence and importance. Descriptive statistics and the items' rank according to the impact factor were computed to determine whether there is a comprehensive instrument available. Thirteen patients and six professionals were included in this study. The patients' age ranged from 24 to 72 years (mean (standard deviation, SD), 50.41 (14.46) years). We obtained a 60-item instrument from the selected questionnaires and subject interviews. Only 12 (37.5 %) out of the 32 best-rated items were verified by the existing instruments, two (6.25 %) were suggested by professionals and 18 (56.25 %) were conclusions from other studies. To the best of our knowledge, this is the first study to provide many features related to the quality of life in patients with maxillary defects.

RESUMEN: Existe escasa discusión en la literatura sobre la calidad de vida de los pacientes con defectos maxilares. Este artículo evalúa los problemas relacionados con esta condición. Realizamos un estudio transversal de pacientes con defectos maxilares de centros de referencia en Brasil. Se desarrolló un cuestionario basado en preguntas de siete instrumentos, que trataba sobre dominios y conclusiones similares a las de otros estudios. La variable de estimación fue la puntuación de los pacientes para cada pregunta. La medida de resultado fue la presencia de los elementos mejor clasificados en el cuestionario como factor de impacto. Seis expertos evaluaron estos ítems y sugirieron qué preguntas incluir o excluir. Los pacientes puntuaron cada ítem según su ocurrencia e importancia. Se calcularon las estadísticas descriptivas y la clasificación de los ítems según el factor de impacto, para determinar si existe un instrumento completo. Trece pacientes y seis profesionales fueron incluidos en este estudio. La edad de los pacientes osciló entre 24 y 72 años [media (desviación estándar), 50,41 (14,46) años]. Obtuvimos un instrumento de 60 ítems de los cuestionarios y entrevistas de temas seleccionados. Solo 12 (37,5 %) de los 32 ítems mejor calificados se verificaron de acuerdo a los instrumentos existentes, dos (6,25 %) fueron sugeridos por profesionales y 18 (56,25 %) fueron conclusiones de otros estudios. De acuerdo a nuestro conocimiento, este es el primer estudio que proporciona características relacionadas con la calidad de vida en pacientes con defectos maxilares.

Reclassification and treatment of odontogenic keratocysts: A cohort study

Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Osteomielitis maxilar y mandibular en pacientes pediátricos / Pediatric maxillary and mandibular osteomyelitis

Introducción: La osteomielitis es un cuadro, de presentación ocasional, que resulta como complicación de diversas etiologías y requiere un tratamiento quirúrgico y médico inmediato. Objetivos: Evaluar los resultados de patología informados como osteomielitis a nivel de los maxilares en pacientes pediátricos, tanto de la mandíbula como del maxilar superior, los cuales requirieron tratamiento quirúrgico y cobertura antibiótica en el periodo del 2008 – 2013. Material y método: Estudio descriptivo y retrospectivo, realizado en el Instituto Nacional de Salud del Niño. Resultados: Se encontró predominio en el sexo masculino (64.7%) y mayor presentación en menores de 10 años de edad (91%), la mandíbula fue en mayor frecuencia afectada (92,1%); con predominio de osteomielitis crónica en 82,4% de los casos. La región del cuerpo y ángulo mandibular resultaron los más afectados con 75 y 62,5% respectivamente. A todos los pacientes se les realizó limpieza quirúrgica y remoción de secuestros óseos con exodoncias de las piezas comprometidas. Conclusión: La cirugía junto a la cobertura antibiótica son la base del tratamiento el cual se busca erradicar el foco infeccioso y al microorganismo patógeno. Proponemos como cobertura antibiótica clindamicina y penicilina resistente a betalactamasa durante 8 semanas, en forma parenteral por 2 semanas como mínimo y luego vía oral hasta completar el tratamiento.

Introduction: Osteomyelitis is a picture of casual presentation, resulting as a complication of various etiologies and requires immediate surgical and medical treatment. Objective: To evaluate the results of pathology-level reported as osteomyelitis of the jaws in pediatric patients , both the jaw and the upper jaw, which required surgical treatment and antibiotic coverage, for the period from 2008 to 2013. Material Methods: Study descriptive, retrospective , held at the National Institute of Child Health Results : predominance was found in males ( 64.7 %) and higher filing under 10 years of age (91%), the mandible was more frequently affected (92.1 %) with a predominance of chronic osteomyelitis in 82.4 % of cases . The region of the mandibular body and angle were the most affected with 75 and 62.5 % respectively. All patients were performed surgical cleaning and removal of sequestra with extractions of compromised parts. Conclusion: Surgery with antibiotic coverage are the mainstay of therapy , which seeks to eradicate the source of infection and the pathogen. We propose as clindamycin antibiotic coverage lactamase resistant penicillin for 8 weeks parenterally for at least 2 weeks and then orally until complete.

Displasia cemento-óssea florida: relato de caso / Florid cemento-osseous dysplasia: case report

A displasia cemento-óssea florida (DCOF) é uma entidade incomum, benigna, frequentemente assintomátíca, limitada aos ossos gnáticos e acomete frequentemente mulheres negras acima de 40 anos. Nos casos com sintomatologia dolorosa, há uma associação com osteomielite crônica, provavelmente decorrente de infecçãso secundária. Esse tipo de lesão possui aspectos radiográficos e histopatológicos encontrados em outras patologias, como osteomielite esclerosante difusa e doença de Paget do osso. O objetivo desse estudo foi revisar a literatura acerca desta lesão, além de relatar um caso clínico de DCOF associada à osteomielite crônica. O exame clínico-anamnésico realizado com destreza, associado aos métodos complementares imagenológicos traz informações importantes para o diagnóstico dessa patologia, modulando os cuidados com os procedimentos cirúrgicos que muitas vezes são necessários para a terapêutica das complicações infecciosas. Por outro lado, procedimentos como exodontias, podem vir a favorecê-las, agravando assim, o quadro clínico do paciente.

Florid cemento-osseous dysplasia (FCOD) is an uncommon benign entity, frequently without painful sintomatology, limited to gnatic bones and occurs frequently in black women, above of 40 years. In cases with painful sintomatology, it has an association with chronic osteomielitis, probably decurrent of secondary infection. This kind of lesion has radiographic and histopathologic aspects found in others pathologies, as diffuse esclerosant osteomielitis and Paget's disease of the bone. The aim of this study was to revise the literature about this lesion, and report a clinical case of FCOD associated with chronic osteomielitis. Physical-anamnesic examination carried through with dexterity, associated to imagenologic complementary methods can bring important information for the diagnosis of this pathology, modulating the cares with the surgical procedures that many times are necessary for the therapeutics of the infectious complications. On the other hand, procedures as exodonties, can come to favor them, thus aggravating, the clinical aspects of the patient.

Incidencia poblacional del pseudoquiste antral en base a radiografías panorámicas / Population incidence of antral pseudocyst based upon panoramic radiographs

El objetivo de este trabajo fue establecer la asiduidad de los signos radiográficos en el uso de la panorámica de las opacificaciones del seno maxilar, compatibles con pseudoquistes antrales, en una población hospitalaria durante el período 1999-2000. Se consideraron las edades, el sexo, correlación radiográfica y nivesl socioeconómico