Lysosomal acid lipase deficiency in pediatric patients: a scoping review

Abstract Objective: Lysosomal acid lipase deficiency (LAL-D) is an underdiagnosed autosomal recessive disease with onset between the first years of life and adulthood. Early diagnosis is crucial for effective therapy and long-term survival. The objective of this article is to recognize warning signs among the clinical and laboratory characteristics of LAL-D in pediatric patients through a scope review. Sources: Electronic searches in the Embase, PubMed, Livivo, LILACS, Web of Science, Scopus, Google Scholar, Open Gray, and ProQuest Dissertations and Theses databases. The dataset included observational studies with clinical and laboratory characteristics of infants, children and adolescents diagnosed with lysosomal acid lipase deficiency by enzyme activity testing or analysis of mutations in the lysosomal acid lipase gene (LIPA). The reference selection process was performed in two stages. The references were selected by two authors, and the data were extracted in June 2020. Summary of the findings: The initial search returned 1593 studies, and the final selection included 108 studies from 30 countries encompassing 206 patients, including individuals with Wolman disease and cholesteryl ester storage disease (CESD). The most prevalent manifestations in both spectra of the disease were hepatomegaly, splenomegaly, anemia, dyslipidemia, and elevated transaminases. Conclusions: Vomiting, diarrhea, jaundice, and splenomegaly may be correlated, and may serve as a starting point for investigating LAL-D. Familial lymphohistiocytosis should be part of the differential diagnosis with LAL-D, and all patients undergoing upper gastrointestinal endoscopy should be submitted to intestinal biopsy.

Parental acceptance toward behavior guidance techniques for pediatric dental visits: a meta-analysis

Abstract This study aimed to answer the following question: What is the proportion of acceptance reported by parents toward pediatric behavior guidance techniques (BGTs)? Observational studies that evaluated parental acceptance of BGTs during pediatric dental visits among parents of non-special health care need (non-SHCN) and SHCN children were included. A search of the Cochrane Library, Latin American and Caribbean Health Sciences (LILACS), MedLine/PubMed, PsycINFO, Scopus, and Web of Science databases, in addition to gray literature, was performed until October 2021. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment. The certainty of evidence was assessed using the Recommendation, Assessment, Development, and Evaluation (Grade). Fifty-three studies with 4868 participants were included, and 42 were retained for the random-effects proportion meta-analysis. The methodological quality varied from low to high. The agreement with the BGTs varied from 85.6% (95%CI: 77.5-92.1; p < 0.001; I 2 = 93.6%; 16 studies; n = 1399) for tell-show-do to 25.7% (95%CI: 17.8-34.4; p < 0.001; I 2 = 90.4%; 12 studies; n = 1129) for passive protective stabilization among non-SHCN children's parents; meanwhile, among the parents of SHCN children, it varied from 89.1% (95%CI: 56.1-99.7; p < 0.001; I 2 = 95.7%; 3 studies; n = 454) for tell-show-do to 29.1% (95%CI: 11.8-50.0; p = 0.001; I 2 = 84.8%; 3 studies; n = 263) for general anesthesia. The effect estimates varied greatly, as substantial heterogeneity across studies was observed, thus limiting the confidence in the results. Parents were more likely to agree with basic BGTs over advanced BGTs, with very low certainty of evidence. Dentists should discuss BGT options with parents. Protocol registration: PROSPERO CRD42018103834.

Diagnostic validity of biomarkers in Parkinson's Disease: systematic review and meta-analysis / Validad diagnóstica de biomarcadores en la enfermedad de Parkinson: una revisión sistemática y metaanálisis / Validade diagnóstica de biomarcadores na doença de Parkinson: revisão sistemática e meta-análise

ABSTRACT Objective: To identify biomarkers for Parkinson's disease, cerebrospinal fluid, blood, saliva, and urine. Method: The studies were collected from the Cochrane, LILACS, PubMed, SCOPUS, WEB OF SCIENCE, OpenGrey, ProQuest and Google Scholar databases starting from May 3, 2016 and updated on March 20, 2017. Twenty-two studies were evaluated, by the Quality Assessment Tool for Diagnostic Accuracy Studies and Review Manager 5.3. Results: Evidence shows that serum antibodies can be used as highly specific and accurate biomarkers for the diagnosis of Parkinson's disease at the outset. Biomarkers in the cerebrospinal fluid are related to increased motor severity, postural instability, gait abnormality, and cognitive impairment. Conclusion: Serum and cerebrospinal antibodies can be used as diagnostic biomarkers at the onset of the disease.

RESUMEN Objetivo: Identificar los biomarcadores para la enfermedad de Parkinson, el líquido cefalorraquídeo, la sangre, la saliva y la orina. Método: Los estudios fueron recolectados en las bases de datos Cochrane, LILACS, PubMed, SCOPUS, WEB OF SCIENCE, OpenGrey, ProQuest y Google Scholar, a partir del 3 de mayo de 2016 y actualizados el 20 de marzo de 2017. Se seleccionaron 22 estudios, evaluados por la Quality Assessment Tool for Diagnostic Accuracy Studies y el Review Manager 5.3. Resultados: La evidencia muestra que los anticuerpos séricos pueden ser utilizados como biomarcadores altamente específicos y precisos para el diagnóstico de la enfermedad de Parkinson en su inicio. Los biomarcadores en el líquido cefalorraquídeo están relacionados con el aumento de la severidad motora, la inestabilidad postural, el disturbio de la marcha y la declinación cognitiva. Conclusión: Los anticuerpos séricos y cefalorraquídeos pueden utilizarse como biomarcadores de diagnóstico al inicio de la enfermedad.

RESUMO Objetivo: Identificar os biomarcadores para a doença de Parkinson, no líquido cefalorraquidiano, sangue, saliva e urina. Método: Os estudos foram coletados nas bases de dados Cochrane, LILACS, PubMed, SCOPUS, WEB OF SCIENCE, OpenGrey, ProQuest e Google Scholar, a partir de 3 de maio de 2016 e atualizados em 20 de março de 2017. Foram selecionados 22 estudos, avaliados pelo Quality Assessment Tool for Diagnostic Accuracy Studies e o Review Manager 5.3. Resultados: A evidência mostra que os anticorpos séricos podem ser usados como biomarcadores altamente específicos e precisos para o diagnóstico da doença de Parkinson em seu início. Os biomarcadores no líquido cefalorraquidiano estão relacionados ao aumento da severidade motora, à instabilidade postural, ao distúrbio da marcha e ao declínio cognitivo. Conclusão: Os anticorpos séricos e cefalorraquidianos podem ser utilizados como biomarcadores de diagnóstico no início da doença.

Diagnostic validity of methods for assessment of swallowing sounds: a systematic review / Validade diagnóstica dos métodos de avaliação dos sons de deglutição: uma revisão sistemática

Abstract Introduction: Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. Objective: This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. Methods: Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Results: The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. Conclusion: Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.

Resumo Introdução: A disfagia orofaríngea é uma comorbidade altamente prevalente em pacientes neurológicos e representa uma séria ameaça à saúde, pode levar a desfechos como pneumonia por aspiração, hospitalização e até morte. A avaliação propõe um método não invasivo, acústico, para diferenciar entre indivíduos com e sem sinais de penetração e aspiração. Objetivo: Esta revisão sistemática analisou a validade diagnóstica de diferentes métodos para avaliação dos sons de deglutição, quando comparados com a videofluoroscopia da deglutição para detectar disfagia orofaríngea. Método: Artigos nos quais o objetivo principal era avaliar a acurácia dos sons de deglutição foram pesquisados em cinco bancos de dados eletrônicos sem limitações de idioma ou tempo de publicação. As medidas de acurácia descritas nos estudos foram transformadas para construir curvas ROC (Receptor Operating Characteristic) e gráfico em floresta (forest plot) com o auxílio do software Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Dinamarca). A metodologia dos estudos selecionados foi avaliada com a ferramenta Avaliação da Qualidade de Estudos de Acurácia de Testes Diagnósticos-2. Resultados: A busca eletrônica final resultou na identificação de 554 artigos; no entanto, apenas três estudos preencheram os critérios de inclusão. Os valores de acurácia (área abaixo da curva) foram 0,94 para microfone, 0,80 para doppler e 0,60 para estetoscópio. Conclusão: Baseado nas evidências limitadas e da baixa qualidade metodológica, pois foram poucos os estudos incluídos, e com pequeno tamanho amostral, de todos os testes diagnósticos (index testes) encontrados para essa revisão sistemática o doppler mostrou excelente acurácia diagnóstica na discriminação dos sons de deglutição, o microfone demonstrou uma boa acurácia na discriminação dos sons de pacientes disfágicos e o estetoscópio revelou o melhor teste de triagem.

Comparative evaluation of somatosensory mechanisms involved in orofacial somatic, visceral and neuropathic pain / Avaliação comparativa dos mecanismos somatossensoriais envolvidos na gênese das dores orofaciais de origem somática, visceral e neuropática

Orofacial pain conditions can be classified into somatic, visceral or neuropathic pain. Somatic pain is triggered by a noxious stimulus generally inducted by peripheral traumas, such as dental implants surgeries (IMP). Visceral pain initiates within internal body tissues and is normally triggered by inflammation, as in inflammatory toothaches (IT). The third condition is neuropathic pain, which results from persistent injury to the peripheral nerve as in Atypical Odontalgia (AO). The aims of this study were: 1- to investigate somatosensory abnormalities, using mechanical, painful, and electrical quantitative sensory testing (QST), in somatic (IMP patients), visceral (IT) and neuropathic pain (AO); 2- to quantify how accurately QST discriminates an IT or AO diagnosis; and 3- to investigate the influence implant surgeries or pulpectomy may have on somatosensory system and sensory nerve fibers. Sixty subjects were divided in three groups: IMP (n = 20), IT (n = 20) and AO group (n = 20). A sequence of five QSTs and the Conditioned Pain Modulation Test (CPM) were performed one month and three months after dental implant surgery (IMP group) or pulpectomy (IT group). AO group was evaluated only at baseline. QST comprehended Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Dynamical Mechanical Allodynia (DMA), Current Perception Threshold (CPT) for A-beta (frequency of 2000Hz), A-delta (250Hz) and C fibers (5Hz) and Temporal Summation Test (TS). "Z" score transformation were applied to the data, and within and between groups were statistically analyzed using two-way ANOVA. In addition, the receiver operating characteristic curve analysis, diagnostic accuracy, sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of QSTs were calculated (α = 5%). The findings of this study proved that: 1- loss of function for touch threshold and electrical threshold of C fibers is present in inflammatory toothache; 2- allodynia, hyperalgesia, gain of function for touch and pain thresholds and impaired pain modulation is detected in atypical odontalgia; 3- some QSTs may be used as complementary tests in the differential diagnosis of atypical odontalgia and inflammatory toothache with strong accuracy; 4- the most accurate QSTs for differential diagnosis between subjects with AO and IT were MDT, MPT and DMA where touch threshold forces > 1 g/mm2 and pain threshold forces > 10g/mm2 can be used to accurately discriminate AO from IT; and 5- no somatosensory modification is found after implant surgery and reduced electrical threshold in C fiber is found for patients with inflammatory toothache after 3 months of pulpectomy.(AU)

As dores orofaciais podem ser classificadas em dores somáticas, viscerais ou neuropáticas. A dor somática está relacionada a um estímulo nocivo evidente, geralmente associada a um trauma periférico, como por exemplo, nas cirurgias de implantes (IMP). As dores viscerais têm origem dentro dos órgãos e cavidades internas do corpo e são ativadas pela inflamação, como no exemplo da dor de dente do tipo Pulpite Aguda (PA). A terceira condição é a dor neuropática, que resulta de uma lesão persistente ao nervo periférico, como ocorre na Odontalgia Atípica (OA). Os objetivos deste estudo foram: 1- avaliar as alterações somatossensoriais, por meio do uso de Testes Sensoriais Quantitativos (TSQ) mecânicos, dolorosos e elétricos em dores somáticas (pacientes IMP), viscerais (PA) e neuropáticas (OA); 2- quantificar a acurácia dos TSQs na descriminação diagnóstica de uma PA ou OA; e 3- investigar alterações somatossensoriais e nas fibras nervosas sensoriais após cirurgia de instalação de implantes dentários ou pulpectomia. Sessenta sujeitos foram divididos em três grupos: IMP (n = 20), PA (n = 20) e OA (n = 20). Uma sequência de cinco TSQs e o teste de Controle da Modulação da Dor (CMD) foram realizados um mês e três meses após cirurgia de implantes (grupo IMP) ou pulpectomia (grupo PA). No grupo OA, os testes foram realizados somente uma vez no início do estudo. Os TSQs englobaram o Limiar de Detecção Mecânica (LDM), Limiar de Dor Mecânica (LDoM), Alodinia Mecânica Dinâmica (AMD), Limiar de Percepção de Corrente (LPC) para fibras A-beta (frequência de 2000Hz), A-delta (250Hz) e C (5 Hz), e o teste de Somação Temporal (ST). A transformação em escores de "Z" foi aplicada aos dados, e diferenças intra e inter-grupos foram analisadas usando ANOVA de medidas repetidas. Ainda, a acurácia diagnóstica dos TSQs foi medida por meio da sensibilidade, especificidade, razão de verossimilhança e razão de chances para diagnóstico (α = 5%). Os resultados deste estudo mostraram que: 1- perda da função em limiar táctil e limiar elétrico de fibras C está presente na Pulpite Aguda; 2- alodinia, hiperalgesia, ganho de função nos limiares de tato e de dor, e modulação da dor prejudicada são encontrados em pacientes com odontalgia atípica; 3- alguns TSQs podem ser usados como testes diagnósticos complementares ao diagnóstico diferencial entre PA e OA; 4- os TSQs com maior acurácia para o diagnóstico diferencial entre indivíduos com PA e OA foram LDM LDoM e AMD, onde uma força maior que 1 g/mm2 para limiar de tato e maior que 10 g/mm2 para limiar de dor podem ser usados com precisão; e 5- nenhuma alteração somatossensorial é encontrada após cirurgia de implantes e uma redução no limiar elétrico em fibras C é encontrado em pacientes com PA após 3 meses da pulpectomia.(AU)

Deep pain sensitivity is correlated with oral-health-related quality of life but not with prosthetic factors in complete denture wearers

ABSTRACT Low pressure Pain Threshold (PPT) is considered a risk factor for Temporomandibular Disorders (TMD) and is influenced by psychological variables. Objectives To correlate deep pain sensitivity of masticatory muscles with prosthetic factors and Oral-Health-Related Quality of Life (OHRQoL) in completely edentulous subjects. Material and Methods A total of 29 complete denture wearers were recruited. The variables were: a) Pressure Pain Threshold (PPT) of the masseter and temporalis; b) retention, stability, and tooth wear of dentures; c) Vertical Dimension of Occlusion (VDO); d) Oral Health Impact Profile (OHIP) adapted to orofacial pain. The Kolmogorov-Smirnov test, the Pearson Product-Moment correlation coefficient, the Spearman Rank correlation coefficient, the Point-Biserial correlation coefficient, and the Bonferroni correction (α=1%) were applied to the data. Results The mean age (standard deviation) of the participants was of 70.1 years (9.5) and 82% of them were females. There were no significant correlations with prosthetic factors, but significant negative correlations were found between the OHIP and the PPT of the anterior temporalis (r=-0.50, 95% CI-0.73 to 0.17, p=0.005). Discussion The deep pain sensitivity of masticatory muscles in complete dentures wearers is associated with OHRQoL, but not with prosthetic factors.

Primary headaches interfere with the efficacy of temporomandibular disorders management

OBJECTIVES: This cross-sectional study aimed to evaluate the influence of Primary Headache (PH) on efficacy of a Temporomandibular Disorders (TMD) conservative therapy and its association with the presence of self-reported parafunctional habits. SAMPLE AND METHODS: Sample was composed of 400 medical records, divided into four groups: I) Muscular TMD (n=64); II) Muscular TMD+PH (n=48); III) Muscular TMD+Articular TMD (n=173); IV) Muscular TMD+Articular TMD+PH (n=115). All groups had undergone a TMD therapy for three months with a stabilization appliance and counseling for habits and behavioral changes, with no specific headache management. Current pain intensity and existence or not of self-reported bruxism were assessed. Repeated measures ANOVA and Chi-Square test followed by Odds were used for statistical analysis, with a significance level of 5%. RESULTS: results of this study showed that: (1) A conservative therapy with stabilization appliance and counseling for habits and behavioral changes was effective in the TMD pain relief; (2) Groups with an additional diagnosis of PH had worsened the pain improvement significantly; and (3) no association between the presence of self-reported bruxism and PH was found. CONCLUSIONS: this study could elucidate the important effect that headache may have on the TMD management. .

Acupuncture therapeutic protocols for the management of temporomandibular disorders / Protocolos de acupuntura para o tratamento da disfunção temporomandibular

BACKGROUND AND OBJECTIVES: For most cases, temporomandibular disorders should be treated by a non-invasive, interdisciplinary and integrative process. In traditional Chinese medicine, acupuncture is an excellent tool aiming at treating and healing this disease. This study was a critical literature review to observe the efficacy of traditional Chinese acupuncture to treat muscular temporomandibular disorders and to identify primary acupoints. CONTENTS: Pubmed, LILACS, Scielo and Cochrane databases were queried to identify scientific articles relevant for the study. Articles were selected from January 2000 to May 2013. A total of 125 articles were found and 21 were included. Acupuncture treatment alone or as additional therapy, or even compared to other techniques, was superior and effective to improve pain and function of patients with temporomandibular disorders and most commonly used acupoints were IG4, E6, E7 and F3. CONCLUSION: This study has shown that acupuncture is a technique recommended by national and international literature to treat muscular temporomandibular disorders, promoting pain relief and/or total intensity, improvement of joint movements and oral function and decrease of masticatory muscles hyperactivity. .

JUSTIFICATIVA E OBJETIVOS: Na grande maioria dos casos, o tratamento das disfunções temporomandibulares deve ser um processo não invasivo, interdisciplinar e integrativo. Dentro da medicina tradicional chinesa, a acupuntura é uma ótima ferramenta que visa a terapia e cura dessas doenças. O objetivo deste estudo foi conduzir uma revisão crítica da literatura para verificar a eficácia da acupuntura tradicional chinesa no tratamento da disfunção temporomandibular do tipo muscular, bem como identificar os principais acupontos. CONTEÚDO: Foi realizada uma pesquisa nas bases de dados Pubmed, LILACS, Scielo e Cochrane para identificar artigos científicos relevantes para o estudo. Os artigos foram selecionados no período de janeiro de 2000 a maio de 2013. Encontrou-se um total de 125 artigos, sendo que 21 foram incluídos. O tratamento de acupuntura isolado ou como terapia complementar, ou ainda comparado com outras técnicas, se mostrou superior e eficiente na melhora da dor e da função de pacientes com disfunção temporomandibular, e os pontos de acupuntura mais citados foram IG4, E6, E7 e F3. CONCLUSÃO: Este estudo demonstrou que a acupuntura é uma técnica recomendada pela literatura nacional e internacional para o tratamento de disfunções temporomandibulares de origem muscular, promovendo alivio e/ou redução total da intensidade dolorosa, melhora nos movimentos mandibulares e na função oral e diminuição da hiperatividade muscular dos músculos da mastigação. .

Dor neuropática orofacial associada à instalação de implantes / Neuropathic orofacial pain associated with implant surgery – literature review

Esta revisão de literatura avaliou a relação entre as dores neuropáticas orofaciais e as lesões neuronais associadas à instalação de implantes dentários, tendo como foco os aspectos clínicos, preventivos e suas opções terapêuticas. Material e métodos: uma revisão de literatura foi realizada tendo como referência as bases de dados PubMed e SciELO. Apenas estudos clínicos publicados entre os anos de 1993 e 2013 foram analisados. Resultados: as ferramentas de busca permitiram a seleção de 18 trabalhos, sendo: seis relatos de casos clínicos, sete estudos observacionais, um ensaio clínico randomizado e quatro revisões da literatura. Grande parte dos trabalhos revelou que as lesões neuronais relacionadas às cirurgias para instalação de implantes são de caráter transitório. Conclusão: o reconhecimento precoce dos sinais e sintomas de lesões neuronais, bem como o acompanhamento do progresso na regeneração nervosa, representam boas práticas clínicas que devem ser aplicadas com o objetivo de evitar a cronificação da lesão...

This literature review evaluated the relationship between neuropathic orofacial pain and the nerve injury associated with dental implants replacement, focusing in the clinical, prevention and management aspects. Material and methods: PubMed and SciELO database were analyzed in this literature review. We considered only clinical studies published between 1993 and 2013. Results: we selected and included 18 articles of which, six were case reports, seven were observational studies, um randomized controlled trial and 4 literature reviews. Most of the articles highlighted the transitory nature of the neuronal damage associated with dental implants replacement. Conclusion: the early recognition of signs and symptoms of neuronal damage, as well as the follow-up during the healing period are good clinical practices and should be endorsed in order to avoid chronifi cation...

Quantitative methods for somatosensory evaluation in atypical odontalgia

A systematic review was conducted to identify reliable somatosensory evaluation methods for atypical odontalgia (AO) patients. The computerized search included the main databases (MEDLINE, EMBASE, and Cochrane Library). The studies included used the following quantitative sensory testing (QST) methods: mechanical detection threshold (MDT), mechanical pain threshold (MPT) (pinprick), pressure pain threshold (PPT), dynamic mechanical allodynia with a cotton swab (DMA1) or a brush (DMA2), warm detection threshold (WDT), cold detection threshold (CDT), heat pain threshold (HPT), cold pain detection (CPT), and/or wind-up ratio (WUR). The publications meeting the inclusion criteria revealed that only mechanical allodynia tests (DMA1, DMA2, and WUR) were significantly higher and pain threshold tests to heat stimulation (HPT) were significantly lower in the affected side, compared with the contralateral side, in AO patients; however, for MDT, MPT, PPT, CDT, and WDT, the results were not significant. These data support the presence of central sensitization features, such as allodynia and temporal summation. In contrast, considerable inconsistencies between studies were found when AO patients were compared with healthy subjects. In clinical settings, the most reliable evaluation method for AO in patients with persistent idiopathic facial pain would be intraindividual assessments using HPT or mechanical allodynia tests.

The coexistence of paroxysmal hemicrania and temporomandibular disorder: Importance of multidisciplinary approach.

Paroxysmal hemicrania (PH) is a trigeminal autonomic cephalalgia, a rare primary headache characterized by unilateral periorbital and/or temporal attacks of severe intensity and short duration. In this situation, the determination of a correct diagnosis is crucial for the establishment of a proper management strategy. In the case of head and facial pain, this step is usually a big challenge since many conditions share the same features, as some primary headaches and temporomandibular disorders (TMD). The relationship between PH and TMD has not been determined. This paper describes a case of a female patient diagnosed with TMD and presenting concomitant headache attacks fulfilling the International Headache Society's criteria for PH. It is also emphasized the importance of dentist in this scenario, for many times responsible for the initial diagnosis of facial/head pain. Moreover, it is presented an integrated and simultaneously approach of both conditions, PH and TMD.

Coronoid process hyperplasia: an unusual cause of mandibular hypomobility

A large number of disorders affecting the masticatory system can cause restriction of mouth opening. The most common conditions related to this problem are those involving the temporomandibular joint (TMJ) and the masticatory muscles, when facial pain also is an usual finding. Congenital or developmental mandibular disorders are also possible causes for mouth opening limitation, although in a very small prevalence. Coronoid process hyperplasia (CPH) is an example of these cases, characterized by an excessive coronoid process growing, where mandibular movements become limited by the impaction of this structure on the posterior portion of the zygomatic bone. This condition is rare, painless, usually bilateral and progressive, affecting mainly men. Diagnosis of CPH is made based on clinical signs of mouth opening limitation together with imaging exams, especially panoramic radiography and computerized tomography (CT). Treatment is exclusively surgical. This paper presents a case of a male patient with bilateral coronoid process hyperplasia, initially diagnosed with bilateral disk displacement without reduction, and successfully treated with intraoral coronoidectomy. It is emphasized the importance of differential diagnosis for a correct diagnosis and, consequently, effective management strategy.

Um grande número de distúrbios pode provocar limitação no grau de abertura bucal. As condições mais comuns relacionadas com esse problema são aquelas que envolvem a articulação temporomandibular (ATM) e músculos mastigatórios, em que, além da limitação, a dor facial é um achado comum. Distúrbios congênitos ou de desenvolvimento da mandíbula também são possíveis causas para limitação de abertura bucal, embora possuam uma baixa prevalência. A hiperplasia do processo coronóide (HPC) é um exemplo dessas causas, caracterizada por um desenvolvimento excessivo do processo coronóide, em que o movimento mandibular torna-se limitado pela impacção dessa mesma estrutura na parte posterior do osso zigomático. Esta condição é rara, indolor, geralmente bilateral e progressiva, afetando principalmente homens. O diagnóstico de HPC é feito por meio dos sinais clínicos de abertura bucal limitada associado com exames de imagem, especialmente a radiografia panorâmica e tomografia computadorizada (TC). O tratamento é exclusivamente cirúrgico. O objetivo desse artigo é apresentar um caso de paciente do sexo masculino com hiperplasia bilateral do processo coronóide, inicialmente diagnosticado com deslocamento de disco sem redução bilateral, e tratado com sucesso com coronoidectomia intraoral. Assim, é enfatizada a importância do diagnóstico diferencial para um correto diagnóstico e, consequentemente, estratégias efetivas de tratamento.