ABSTRACT
Abstract The aim of this retrospective cross-sectional investigation was to perform a 3D analysis of craniofacial morphology of patients with unilateral cleft lip and palate (UCLP) at two stages of skeletal maturation. Cone-beam computed tomography (CBCT) scans of 52 UCLP patients (34 prepubertal; 18 pubertal) were collected from an outpatient referral center for the treatment of craniofacial deformities. In total 15 multiplanar craniofacial landmarks were identified, 3D virtual surface models were created, and 13 variables were measured to assess the 3D Euclidean distances between landmarks and spatial position of the landmarks in the projected X, Y and Z components. Maxillary and mandibular pitch (clockwise, counterclockwise) rotation relative to the cranial base was also evaluated. The significance level was set at 5%. Maxillary retrusion value relative to the cranial base was higher and statistically significant greater (p = 0.028) in pubertal (SNA, 77.4° ± 6.2; N-ANS Y, 3.3 mm ± 3.1) than in prepubertal patients (SNA 81.0° ± 5.2; N-ANS Y, 5.8 mm ± 2.7). The posterior cranial base length (S-Ba Y) was significantly longer (p = 0.013) in pubertal (20.7 mm ± 3.4) than in prepubertal patients (18.4 mm ± 2.7). The upper facial height (N-ANS Z) was significantly greater (p = 0.01) in pubertal (46.9 mm ± 4.5) than in prepubertal patients (43.4 mm ± 3.0). Prepubertal and pubertal UCLP patients presented distinct patterns of craniofacial morphology, mainly in the sagittal component of the maxilla and in the posterior cranial base length. Pubertal patients had greater maxillary retrusion and posterior cranial base length.
ABSTRACT
ABSTRACT Jaw metastasis can be mistaken for inflammatory or infectious diseases. Then, they should be considered in the differential diagnosis of unknown jaw lesions. Study reported here involved metastasis of breast cancer in the mandible of a 45-year-old woman. The most important differential diagnostic was a reactive lesion in an unusual periapical location associated with a nonvital tooth. However, given patient's medical history and because paresthesia and pain were observed a few days after pulpectomy, metastasis of breast cancer could not be ruled out. When bone scintigraphy suggested the metastasis of a malignant bone tumor, incisional biopsy was performed. Histopathologic examination and immunohistochemical reaction confirmed the diagnosis of metastasis of breastcancer, and chemotherapy was thus performed as well. Unfortunately, patient died 2 years after diagnosis. Dentists as well as general physicians should therefore consider presence of oral metastasis in cases involving atypical symptoms, especially in patients with known malignant disease.
RESUMO As metástases mandibulares podem ser confundidas com doenças inflamatórias ou infecciosas. Sendo assim, elas devem ser consideradas no diagnóstico diferencial de lesões desconhecidas na mandíbula. Esse relato de caso envolveu metástase de câncer de mama na mandíbula de uma mulher de 45 anos. O diagnóstico diferencial mais importante foi uma lesão reacional, em uma localização periapical incomum, associada a um dente não vital. No entanto, dado o histórico médico da paciente e uma vez que parestesia e dor foram observadas alguns dias após a realização da pulpectomia, a metástase de câncer de mama não foi descartada. Quando a cintilografia óssea sugeriu a metástase de um tumor ósseo maligno, uma biópsia incisional foi realizada. O exame histopatológico e a reação imunohistoquímica confirmaram o diagnóstico de metástase do câncer de mama, e a quimioterapia foi então realizada. Infelizmente, a paciente morreu 2 anos após o diagnóstico. Portanto, dentistas e médicos generalistas devem considerar a presença demetástases oral em casos que envolvam sintomas atípicos, principalmente em pacientes com doença maligna conhecida.
ABSTRACT
ABSTRACT: Carotid stenosis usually results from the accumulation of atherosclerotic plaque in the carotid artery wall and is an important risk factor for ischemic cerebral vascular accident (CVA). This study describes the importance of diagnostic imaging exams used in dentistry for the early identification of atheroma plaques in the extracranial and intracranial internal carotid artery. A male patient was referred to a radiology clinic to perform panoramic radiography (PR) and a cone beam computed tomography (CBCT) to develop treatment plan options. In the PR and CBCT a radiopaque image, suggestive of atheroma in the extracranial internal carotid artery, was observed on the right side. The diagnosis was confirmed by color DOPPLER ultrasonography. In the CBCT, the presence of calcifications in the intracranial internal carotid artery was also observed. Diagnostic imaging exams used in dentistry allow the identification of asymptomatic individuals, facilitating early intervention and consequent reduction in the risk of ischemic CVA.
RESUMEN: La estenosis carotídea generalmente es consecuencia de la acumulación de placa aterosclerótica en la pared de la arteria carótida y es un factor de riesgo importante para el accidente cerebral vascular (ACV) isquémico. Este estudio describe la importancia de los exámenes de diagnóstico por imágenes utilizados en odontología para la identificación precoz de placas de ateroma en la arteria carótida interna, a nivel extracraneal e intracraneal. Un paciente masculino fue remitido a una clínica de radiología para realizar una radiografía panorámica (RP) y tomografía computarizada de haz cónico (TCHC) para analizar opciones de tratamiento. En el RP y TCHC se observó una imagen radiopaca, sugestiva de ateroma en la arteria carótida, extracraneal, en el lado derecho. El diagnóstico fue confirmado por ultrasonido DOPPLER color carotídeo. En el TCHC, también se observó la presencia de calcificaciones en la arteria carótida interna, intracraneal. Los exámenes de imagenología diagnóstica utilizados en odontología permiten la identificación de individuos asintomáticos, lo que facilita la intervención temprana y la consiguiente reducción en el riesgo de ACV isquémico.