Osteonecrosis mandibular inducida por bifosfonatos en un anciano / Mandibular osteonecrosis induced by biphosfonates in an elderly

Se describe el caso de un anciano de 67 años de edad quien fue asistido en el Servicio de Cirugía Maxilofacial de la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, remitido del Hospital Oncológico Provincial Docente Conrado Benítez por presentar tejido necrótico en el sector inferior de la mandíbula. Luego de realizados el examen clínico y los estudios complementarios pertinentes, además de establecido el presunto diagnóstico de osteonecrosis mandibular inducida por bifosfonatos, se decidió practicar la exéresis de la porción necrosada, a la cual se le efectuó estudio histopatológico que confirmó la existencia de la enfermedad ósea. La evolución posoperatoria fue satisfactoria; no hubo proceso inflamatorio excesivo ni dehiscencia de la herida quirúrgica.

The case report of a 67 years elderly is described. He was assisted in the Maxillofacial Surgery Service of Mártires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba, referred from Conrado Benítez Teaching Provincial Cancer Hospital due to necrotic tissue in the inferior sector of the jaw. After the clinical and complementary exams, and also establish the presumed diagnosis of mandibular osteonecrosis induced by biphosfonates, it was decided to practice the exeresis of the necrotic bone portion, to which a histopathologic study was carried out that confirmed the existence of the disease. The postoperative evolution was satisfactory; there were not excessive inflammatory process neither dehiscence of the surgical wound.

Trastornos temporomandibulares en pacientes bruxópatas, trabajadores de estomatología de Mayarí / Temporomandibular Disorders in Patients with Bruxism, Dentistry Workers of Mayarí

Introducción: el estrés es una enfermedad omnipresente en la sociedad industrial actual. El aparato estomatognático sufre, con frecuencia, los impactos nocivos de la vida moderna. Numerosos estudios tratan de dilucidar la relación existente entre el bruxismo y los trastornos temporomandibulares. Objetivo: determinar la frecuencia de trastornos temporomandibulares a un grupo de pacientes bruxópatas, trabajadores de estomatología del municipio Mayarí en Holguín. Método: se realizó, desde octubre 2014 a enero 2015, un estudio de serie de casos en 70 trabajadores de estomatología, se diagnosticaron 49 pacientes bruxópatas entre 19 y 59 años, de ambos sexos en Policlínico Universitario "26 de Julio". Los resultados se presentaron en tablas de análisis de frecuencia simple, las cifras se dieron en valores absolutos y porcentaje. Para procesar los datos se utilizó procesador Microsoft Excel XP. Resultados: de 49 pacientes bruxópatas diagnosticados, 30 presentaron trastornos temporomandibulares para el 61,2%. Predominó el grado de disfunción leve con 20 pacientes para el 66,7% seguido del moderado y severo en orden decreciente con menor número de casos. La presencia de ruidos articulares fue la manifestación clínica más frecuente en este estudio en el 83,3% de los pacientes con trastornos temporomandibulares, seguido del dolor muscular en el 63,3% y la limitación de los movimientos en el 33,3%. Se evidenció una prevalencia de pacientes del sexo femenino para el 67%, con relación al masculino para el 33% y el grupo de edad con mayor representación de afectados fue de 40 a 49 años para el 60%. Conclusiones: los resultados del estudio indicaron que la frecuencia de trastornos temporomandibulares en los pacientes bruxópatas estudiados fue alta, con más de la mitad de los afectados.

Introduction: stress is an universal condition in the industrial society of our days. The estomatognatic device usually suffers the harmful impacts of modern life. Several studies try to explain the current relationship between the bruxism and the temporomandibular disorders. Objective: to estimate the frequency of temporomandibular disorders in a group of bruxer patients, of dentistry workers of Mayarí, Holguín. Method: a case series study, was carried out from October 2014 to January 2015 in 70 stomatology workers, 49 patients with bruxism between 19 and 59 years old, of both sexes, were diagnosed at 26 de Julio Teaching Polyclinic. Results: of 49 patients, 30 had temporomandibular disorders for 61.2%. There was a slight degree of dysfunction that predominated in 20 patients for 66.7%, followed by a declining moderate and severe order with lower number of cases. The presence of articular noises was the most frequent clinical manifestation showed study with 83.3% of the patients with temporomandibular disorders, followed by the muscular pain in 63.3% and the limitation of the movements in 33.3%. The female sex was the prevailing one 67% in relation with the male ones for 33% and the age group was from 40 to 49 years was the most representative for 60%. Conclusions: the results of the study showed that the frequency of temporomandibular disorders in the studied bruxer patients was high, with more than half of the affected ones.

Granuloma central de células gigantes: presentación de diez casos / Central giant cell granuloma: presentation of ten cases

Fundamento: el granuloma central de células gigantes (GCCG) es una lesión que ocupa el 7 % de los tumores benignos que se encuentra exclusivamente en los maxilares. Se presenta con más frecuencia en mujeres que en hombres y predomina en la segunda y tercera década de la vida. Las características radiográficas del GCCG son variables y pueden ser confundidas con otras lesiones de los maxilares. El GCCG puede tener un comportamiento agresivo lo que permite establecer el tratamiento de elección, incluyendo la enucleación, el curetaje y la resección en bloque de la lesión. Caso clínico: se presentaron diez casos de pacientes diagnosticados con GCCG. El 80 % de los casos se localizaron en la mandíbula con las siguientes características clínicas: asimetría facial, desplazamiento dental, reabsorción radicular, alteración de la oclusión y trastorno nervioso. Conclusiones: en cuatro sujetos se realizó resección en bloque con placa de reconstrucción, mientras que en los otros seis pacientes se llevó a cabo enucleación y curetaje. En el 100 % de los casos se efectuó un abordaje intraoral y no se presentaron complicaciones graves. El seguimiento clínico y radiográfico evidenció recidiva en uno de los pacientes, razón por la cual se precedió a realizar resección en bloque con placa de reconstrucción.

Background: central giant cell granuloma (CGCG) is a lesion that occupies 7 % of benign tumors found exclusively in the jaws. It occurs more frequently in women than in men and predominates in the second and third decades of life. Radiographic features of CGCG are changeable, and may be confused with other jaws' lesions. The CGCG may have aggressive behavior which allows setting the treatment of choice, including enucleation, curettage and resection of the lesion. Clinical case: ten cases of patients diagnosed with CGCG were presented. The 80 % of the cases were located in the jaw with the following clinical features: facial asymmetry, dental displacement, root resorption, altered occlusion and nerve disorder. Conclusions: in four patients resection in block was performed with reconstruction plate, while in six other patients enucleation and curettage was carried out. In the 100 % of the cases an intraoral approach was made without severe complications. There was clinical and radiographic evidence of recidivation in one of the patients, a resection with reconstruction plate was made.

Treatment of large sized cystic lesion of the jaws with specific appliance for decompression: cases report

Cystic lesions on the jaws with expansion can invade the adjacent anatomical structure, infiltrate and expand the jaws, cause facial deformity, etc. There is great potential for pathologic fractures after cyst enucleation, and damage to the major structures like the nerve, artery. For these reasons, marsupialization and decompression are commonly used to reduce the cystic size. In 1947, Thomas first mentioned decompression that reduces the osmotic pressure in a cyst by making a hole in the cyst and insert a drain. In our cases, a large sized cystic lesion was treated with a specific device made from an orthodontic band and spinal needle. This device is easy and effective for applications and self irrigation.

Displasia fibrosa da mandíbula / Fibrous dysplasia of mandible

A displasia fibrosa da mandíbula é uma patologia óssea benigna que representa cerca de 2% de todos os tumores ósseos. Relatamos o caso de uma paciente de 11 anos de idade, com queixa de dor em região mandibular esquerda há 1 semana, com história de abaulamento da mesma região há 3 meses. Após realização de exames de imagem, foi diagnosticado displasia fibrosa da mandíbula. O objetivo deste relato é revisar as principais características clínicas, radiológicas e possíveis tratamentos para o caso, dando a devida importância para o seguimento ambulatorial pós-tratamento

Fibrous dysplasia is a benign bone disease which represents about 2% of all bone tumors. Here we report the case of an 11-year-old who complained of pain at the left mandible area for a week, with history of arching in this area for 3 months. Imaging examinations led to the diagnosis of fibrous dysplasia of the mandible. The aim of this work is to review the main clinical and radiological characteristics and possible treatments for the case, giving due importance to ambulatory follow-up care

Tratamento cirúrgico de extenso cisto odontogênico glandular: considerações clínico-cirúrgicas / Surgical treatment of an extensive glandular odontogenic cyst: a case report

O Cisto Odontogênico Glandular (COG) é um cisto raro que foi descrito inicialmente por PAdayache e Van Wyk em 1987, sob o termo cisto ?sialo-odontogênico?. Entretando, seu nome foi alterado para Cisto Odontogênico Glandular por Gardner et al. em 1988, em virtude da falta de evidência de sua possível origem glandular e para enfatizar a derivação odontogênica desse cisto. Esse termo foi posteriormente adotado pela Organização Mundial de Saúde. Clinicamente, um aumento de volume de crescimento lento e assintomático é observado frequentemente, na região anteior de mandíbula (85%), e uma leve predileção para os homens pode ser vista. Radiograficamente, esses cistos podem ser uniloculares ou multioculares com uma borda bem definida, e, embora nenhuma das características clínicas ou radiográficas do COG seja única ou patognomônica, a lesão tem um comportamento potencialmente agressivo. Na literatura, recomendações para o tratamento dessa entidade têm sido esporádicas e não baseadas em evidências. Este artigo tem o objetivo de relatar o caso de um paciente do sexo masculino, leucoderma, 33 anos de idade, que procurou o departamento de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Pernambuco devivo a um aumento de volume na região anterior de mandíbula, com dois anos de evolução. Uma biópsia incisional foi realizada, e, após o diagnóstico histológico de COG, procedeu-se ao tratamento cirúrgico da lesão por meio de osteotomia periférica. Atualmente, o paciente está em controle pós-operatório de dois anos e meio, sem recorrência da lesão.

Glandular Odontogenic Cyst (COG) is a rare odontogenic cyst that was first described by Padayachee and Van Wyk in 1987 under the term ? sialo-odontogenic cyst?. However , its name was changed to Glandular Odontogenic Cyst by Gardner et al in 1988 because of the lack of evidence of salivary gland origin and to emphasize the odontogenic derivation of this cyst. The term was later adopted by the World Health Organization. Clinically, an asymptomatic slow-growing swelling is observed frequently in the anterior region of the mandible( 85%), and a slight predilection for men can be seen, with a female-to-male ratio of 19:28. Radiologically, these cysts may be unilocular or multilocular with a well-defined border, and although none of the clinical or radiographic features of GOC are unique or pathognomonic, the lesion has a potentially aggressive behavior. Recommendations for treatment in the literature have been sporadic and are not supported by evidence-based data. This paper aims to report the case of a male, leucoderma, 33 years old, who sought the department of Maxillofacial Surgery due to painless swelling in anterior region of the mandible with two years of evolution. Incisional biopsy was performed, and after the histological diagnosis of COG, proceeded to the surgical treatment of lesion through peripheral osteotomy. Currently,the patient is in postoperative control of two and half years, without recurrence of the lesion.

Tratamento de mandíbulas atróficas / Atrophic mandible treatment

A atrofia mandibular é uma doença universal caracterizada pela extensa reabsorção óssea com consequências graves aos pacientes. A instabilidade da prótese total devido à reabsorção mandibular leva a deficiência mastigatória, dores decorrrentes da compressão do nervo mentual, alterações estéticas, fonéticas e psicológicas. Durante décadas os cirurgiões maxilofaciais apresentaram inúmeros procedimentos cirúrgicos com vistas ao tratamento da atrofia mandibular. Entretanto o fenômeno das recidivas estava presente na quase totalidade das técnicas cirúrgicas empregadas. O tratamento atual alia modernas técnicas de enxertia óssea associada aos implantes osseointegrados permite a reabilitação protética ideal nestes pacientes, pois, devolve a forma e o contorno mandibular, além de permitir a confecção de próteses sobre implantes. Este artigo apresenta uma revisão de literatura sobre o tema atrofia da mandíbula, bem como relata o tratamento de um paciente com uma mandíbula severamente reabsorvida tratada pela técnica da enxertia óssea com expansão de tecidos moles e implantes imediatos.

The atrophy mandibular is an universal disease characterized by the extensive bone reabsorption with serious consequences to the patients. The instability of the total prosthesis due to the reabsorption mandibular takes the deficiency mastigatory, pains because of the compression of the nervementual, aesthetic alterations, phonetics and psychological. During decades the maxilo-facial surgeons presented countless surgical procedures with views to the treatment of the atrophy mandibular. However the phenomenon of the recurrences was present in the almost totality of the techniques surgical maids. The current treatment allies modern techniques of bone graft associated to the dental implants allows the ideal prosthetic rehabilitation in these patient ones because it returns the form and the outline mandibular, besides allowing the making of prostheses on implants. This article presents a revision of the literature on the theme atrophy of the jaw, as well as he/she tells a patient’s treatment severely with a jaw reabsorbed treated by the technique of the bone graft with expansion of soft tissue and immediate dental implants.

Manejo fonoaudiológico de los trastornos de la ATM: [revisión] / Phonoaudiologic manage in ATM disease

Este artículo presenta un esquema de la importancia de las articulaciones témporomandibulares (ATMs), sus movimientos y estabilidad en la producción del función, detallando su influencia en cada uno de los subprocesos de esta función. También hace referencia a un protocolo global de evaluación y tratamiento fonoaudiológico de la comunicación oral sonora (habla) para personas que presentan desórdenes en las ATMS como una contribución al trabajo del equipo de salud encargado del tratamiento de las enfermedades de las articulaciones cráneo-mandibulares.

This article presents an outline of the importance of the temporomandibular joint (TMJ) function. Its movements and stability in the production of the speech. This also do reference to a global protocol of evaluation and treatment of the speech for people that present TMJ disorders as a contribution to the Health Team for a better treatment of cranial-mandibular diseases.

Curved-osteotomy for prominent mandibular angle through intra-and extra-oral approach with a small incision / 中华医学美学美容杂志

Objective To study a simple, safe and effective way in correction of prominent mandibular angle. Methods Curved osteotomy was employed for prominent mandibular angle through intra and extra oral approach with a small incision in 20 cases.Partial masseter resection was performed simutaneously in 5 cases with masseter hypertrophy, buccal fat pads were resected in 3 cases with broad faces, and genioplasty were performed in 3 cases with micrognathia. Nine cases only suffering from prominent mandibular angle were underwent curved osteotomy reconstruction. Results A series of 20 cases was followed up from six months to six years, in which 95 % was satisfactory.Conclusion The advantages of this method are simple, safe and symmetric with better result. It is easy to dissect under periosteum and perform curved osteotomy with less complication, quick recovery, and better contouring.

Valor de la decorticación en el tratamiento de la osteomielitis esclerosante difusa de la mandíbula / Value of decortication in the treatment of diffuse sclerosing osteomyelitis of the mandible / Valeur de la décortication dans le traitement de l´ostéomyélite sclérosante diffuse de la mandibule

Se evaluó retrospectivamente a 16 pacientes con osteomielitis esclerosante difusa de la mandíbula, a los cuales se hicieron 27 decorticaciones. Más de la mitad de ellos se mantuvieron asintomáticos durante 3,9 años después de la cirugía, mientras que en los restantes se realizó la decorticación entre 2 y 5 ocasiones, pero los síntomas recurrieron a los 6,3 meses como promedio después de la operación. Variables como sexo, localización, extensión y cronicidad de la enfermedad no parecieron influir en los resultados, pero sí la edad, la condición dentaria en el área afectada o adyacente a ella y la ejecución deficiente de la técnica quirúrgica; estos 2 últimos aspectos como posibles causas de los fracasos. En cuanto a los promisorios resultados obtenidos en 5 pacientes en los cuales había fallado la decorticación, la aplicación de terapéutica con miorrelajantes y retroalimentación muscular -basada en la hipótesis de que dicha osteomielitis constituye una hiperplasia ósea reactiva atribuible a una tendoperiostitis crónica por hiperfusión de los músculos masetero y digástricos- abre nuevos horizontes en el tratamiento de estos casos.

16 patients with diffuse sclerosing osteomyelites of the mandible, among whom 27 decortications were performed, were retrospectively evaluated. More than half of them were asymptomatic during 3.9 years after surgery, whereas the rest underwent decortication from 2 to 5 times. Symptoms recurred at 6.3 months as an average after the operation. Variables such as sex, localization, extension and chronicity of the disease did not seem to influence on the results, but age, the dental condition in the affected area or close to it and the deficient execution of the surgical procedure did affect the results. The two last aspects were considered as possible causes of the failures. As regards the promissory results obtained in 5 patients in whom decortication had failed, the application of therapeutics with myorelaxants and muscular feedback-based on the hypothesis that such osteomyelitis is a reactive osteal hyperplasia attributed to a chronic tendoperiostitis by hiperfusion of the masseter and digastric muscles- opens new horizons in the treatment of these cases.

Una évaluation rétrospective de 16 patients atteints d´ostéomyélite sclérosante diffuse de la mandibule, sur lesquels on a pratiqué 27 décortications, a été réalisée. Plus de la moitié d´entre eux est restée asymptomatique lors de 3,9 ans après la chirurgie, tandis que la décortication a été effectuée sur le reste entre 2 et 5 fois, mais les symptômes ont réapparu à 6,3 mois en moyenne après l´opéation. Des variables tels que le sexe, la localisation, l´ extensión et la cronicité de la maladie n´ont pas semblé influer dans les résultats, mais l´âge, la condition dentaire dans la région atteinte ou voisine à celle-ci et la réalisation déficiente de la technique chirurgicale; ces deux derniers aspects en tant que possibles reisons des échec. Quant aux résultats prometteurs obtenus chez 5 patients, dont la déocortication avait échoué, l´application de thérapeutiques par myorelaxants et par rétro-alimentation des muscles -basées sur l´hypothèse que la soi-disante osteomyélite constitue une hyperplasie osseuse réactive attribuible à une tendopériostite chronique par hyperfusion des muscles masséter et disgastriques- ouvre de nouveaux horizons dans le traitement de ces cas.