Epidermoid Cyst: Case Report of an Unusual Location.

Aim: The aim of this study is to describe an unusual case of an Epidermoid Cyst (EC) of the tongue treated by a Potassium Titanium Phosphate (KTP) laser. Presentation of Case: A 38 young male patient came to our attention since a little painless swelling, yellowish, on the lateral left side of the tongue. After an accurate clinical examination, a surgical excision with a KTP laser was performed. Control at 7 and 21 days showed a complete healing of lesion and the histological diagnosis was EC. Discussion: EC generally appear like a firm, usually painless swelling that sometimes raises the tongue. In the differential diagnosis of the EC the clinician has to consider a wide range of pathologic conditions that could be classified as development, neoplastic and infective pathologies. Surgical enucleation is the only effective treatment for these kinds of lesions and prognosis is very good, with a very low incidence of relapse. Conclusion: Several techniques are reported in the literature but the use of KTP laser for the excisional biopsy of ORAL EC is very effective, since the relative ease and speed of execution, the compliance of patience, the absence of bleeding and suture.

Excision of oral mucocele by different wavelength lasers.

Background: Mucocele is a common benign neoplasm of oral soft tissues and the most common after fibroma. It generally occurs in the lower lip and its treatment includes excision of cyst and the responsible salivary gland, in order to prevent recurrences. Aims: To evaluate the capability of three different lasers in performing the excision of labial mucocele with two different techniques. Materials and Methods: In the presented cases, excision was performed using two different techniques (circumferential incision technique and mucosal preservation technique) and three different laser wavelengths (Er,Cr:YSGG 2780 nm, diode 808 nm, and KTP 532 nm). Results: All the tested lasers, regardless of wavelength, showed many advantages (bloodless surgical field, no postoperative pain, relative speed, and easy execution). The most useful surgical technique depends on clinical features of the lesion. Conclusion: Tested lasers, with both techniques, are helpful in the management of labial mucocele.

Subcutaneous emphysema during third molar surgery: a case report

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

A extração de terceiros molares é o procedimento cirúrgico mais comum na prática diária em cirurgia oral, e complicações podem ocorrer a despeito da habilidade e experiência do cirurgião. Complicações observadas durante ou após extração de terceiros molares podem incluir dor, edema, sangramento, infecção, perfuração de seio e dano nervoso. Felizmente, a incidência de tais eventos é baixa quando se emprega conduta adequada e boa técnica cirúrgica. O enfisema subcutâneo associado à extração dentária ocorre quando o ar da turbina de alta rotação é forçado para dentro dos tecidos moles através de um retalho rebatido e invade os tecidos adjacentes, causando edema, crepitação à palpação, e eventualmente espalhando-se pelos espaços teciduais dos planos fasciais. Embora seja raro, o enfisema subcutâneo iatrogênico pode ter conseqüências sérias e com risco de morte. É necessário ter cuidado com o uso de turbinas de alta rotação durante a realização de procedimentos cirúrgicos orais. A penetração de ar nos tecidos faciais não está limitada às extrações dentárias, e pode ocorrer também por outras vias de acesso, tais como dentes tratados endodonticamente, periodonto e lacerações de tecidos moles intraorais. Quando ocorre, o enfisema subcutâneo deve ser diagnosticado rapidamente e tratado adequadamente para diminuir o risco de outras complicações. Este relato apresenta um caso de enfisema subcutâneo ocorrido durante a extração de um terceiro molar inferior com emprego de turbina de alta rotação. O manejo do caso é descrito e os aspectos relacionados ao diagnóstico e à prevenção desta complicação cirúrgica são discutidos.