Epidemiological and Clinicopathological Analysis of Odontogenic Tumors: A 20-Year Study

ABSTRACT Objective: To perform the epidemiological and clinicopathological analyses of odontogenic tumors in Kerman for 20 years. Material and Methods: The present study investigated collected records from pathology departments of the Faculty of Dentistry, Bahonar, and Shafa teaching-medical hospitals for 20 years. Data on odontogenic tumors was recorded based on age, sex, and tumor location in the information forms. The statistical t-test and the Kappa coefficient computer codes were utilized for data analysis. Results: 38 samples of odontogenic tumors were considered in the present study. The mean age of participants was 31.7± 10.3 years. The frequency of tumors was higher in women (63.2%) and in the lower jaw) 78.9%). Among various tumors, ameloblastoma (63.1%) and odontoma (18.4%) were the most common tumors, respectively. The correlation between clinical and histopathologic diagnoses was 71.8% using the kappa coefficient. Conclusion: Ameloblastoma is the most common odontogenic tumor. The incidence of lesions was higher in the mandible, and odontogenic tumors were higher in women. Since the diagnosis of odontogenic tumors is based on radiographic and histologic appearances, clinical physicians and pathologists should collaborate for the definitive diagnosis of the disease.

Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

Effect of low concentration of sodium fluoride on osteogenic/odontogenic differentiation of human dental pulp cells / 口腔疾病防治

Objective@#To study the effect of low concentrations of sodium fluoride on the osteogenic/odontogenic differentiation of human dental pulp cells (hDPCs) in vitro.@*Methods@#This study was reviewed and approved by the Ethics Committee. hDPCs were cultured using a modified tissue explant technique in vitro. The effects of different concentrations of sodium fluoride on the proliferation of hDPCs were measured by methylthiazol tetrazolium (MTT) assay. Appropriate concentrations were added to the osteogenic/odontogenic differentiation induction medium, and the cells were induced in vitro. Alizarin red S staining was used to detect the osteoblastic/odontogenic differentiation ability of the cells, and the mRNA expression of the key differentiation factors was detected by RT-qPCR. Moreover, the expression of key molecules of endoplasmic reticulum stress (ERS) was detected by RT-qPCR and Western blot. The data were analyzed with the SPSS 18.0 software package.@*Results@#Low concentration of NaF (0.1 mmol/L) could stimulate cell proliferation in vitro, while a high concentration (5-10 mmol/L) could inhibit cell proliferation (P<0.05). According to the literature and the experimental data, 0.1 mmol/L NaF was selected as the following experimental concentration. The levels of alizarin red S staining were increased after NaF induction of mixed osteogenic/odontogenic differentiation in vitro. The mRNA expression levels of key molecules for osteogenic/odontogenic differentiation, dentin sialophosphoprotein (DSPP), bone sialoprotein (BSP) and osteocalcin (OCN), were increased (P<0.05). The mRNA levels of ERS markers (splicing x-box binding protein-1 (sXBP1), glucose-regulated protein 78 (GRP78) and activating transcription Factor 4 (ATF4) were increased in NaF-treated cells. The protein expression levels of key ER stress molecules (phosphorylated RNA-activated protein kinase-like ER-resident kinase (p-PERK), phosphorylated eukaryotic initiation factor-2α (p-eIF2α) and ATF4) were higher in NaF-treated cells.@*Conclusion@#A low concentration of NaF promotes the osteogenic/odontogenic differentiation of hDPCs and increases the level of ER stress.

Fibro-odontoma Ameloblástico: Revisión de la Literatura a Propósito de un Caso

El fibro-odontoma ameloblástico (FOA) es una neoplasia odontogénica benigna poco frecuente que afecta a los huesos maxilares. Posee un componente de tejido epitelial y ectomesénquima, por lo que hasta hace un tiempo era incluido dentro de la clasificación de tumores odontogénicos de origen mixto. Actualmente estas lesiones no están incorporadas en la última clasificación de los tumores odontogénicos y huesos maxilofaciales de la organización mundial de la salud y son consideradas como un odontoma en desarrollo. Clínicamente se presenta con mayor frecuencia en mandíbula y asociado a la falta de erupción de un diente. Presentamos el caso clínico de un niño de 6 años de edad que acudió a nuestro servicio maxilofacial por la no erupción de un diente temporal mandibular. El cuadro clínico y las investigaciones confirmaron la hipótesis diagnóstica de FOA con una impactación del segundo molar temporal inferior izquierdo hacia el margen basilar mandibular y el germen dentario del premolar por sobre la corona del diente retenido.

Ameloblastic fibro-odontoma (AFO) is a rare benign odontogenic neoplasm that affects the maxillary bones. It possesses both an epithelial and ectomesenchymal component, for which it was previously included in the classification of mixed odontogenic tumors. The AFO is currently not included in the latest classification of odontogenic and maxillofacial bone tumors, and is considered a developing odontoma. Clinically, it predominantly manifests in the mandible, in frequent association with the lack of eruption of a tooth. In this article, the authors present a case of a 6 year old boy with the query of an unerupted primary mandibular tooth. Both the clinical examination and the subsequent investigation confirmed the diagnostic hypothesis of an AFO with subsequent impaction of the primary left mandibular second molar, which was displaced against the base of the mandible, and the tooth germ for the left mandibular second premolar positionedover the crown of the retained tooth.

Actualización en el Diagnóstico y Tratamiento del Fibroma Ameloblástico: Revisión Sistemática

El fibroma ameloblástico (FA) es una neoplasia benigna con potencial de recurrencia y transformación maligna que afecta los huesos maxilofaciales. Se analizaron casos recientes de FA para describir sus características clínicas y opciones de tratamiento. El objetivo de este estudio es mejorar la comprensión de esta enfermedad poco común y brindar información relevante para el diagnóstico y manejo de los pacientes. Se realizó una revisión de la literatura en busca de reportes de caso de FA publicados en los últimos 5 años. Después de eliminar duplicados, se seleccionaron 16 estudios para su análisis. Se recopilaron datos sociodemográficos, ubicación de la lesión, signos clínicos, hallazgos radiográficos y opciones de tratamiento. Los estudios incluidos en el análisis reportaron casos de FA en pacientes con edades entre 4 y 21 años. Se observó una ligera predominancia en hombres. La ubicación más común de la lesión fue la mandíbula posterior. Los signos clínicos más frecuentes fueron el aumento de volumen óseo y el dolor. Radiográficamente, se encontraron principalmente lesiones radiolúcidas multiloculares. El tratamiento más común fue la enucleación de la lesión. No se observaron recurrencias durante el seguimiento de los casos reportados. Los resultados coinciden con la literatura reciente, proporcionando información actualizada sobre el perfil clínico y radiográfico del FA. La enucleación se muestra como una opción efectiva de tratamiento. Estos hallazgos contribuyen al diagnóstico preciso y al manejo adecuado de los pacientes con FA, resaltando la importancia de comprender las características clínicas de esta neoplasia.

Ameloblastic fibroma (AF) is a benign neoplasm with the potential for recurrence and malignant transformation that affects the maxillofacial bones. Recent cases of AF were analyzed to describe their clinical characteristics and treatment options. The objective of this study is to enhance understanding of this rare disease and provide relevant information for the diagnosis and management of patients. A literature review was conducted to identify case reports of AF published in the past 5 years. After removing duplicates, 16 studies were selected for analysis. Sociodemographic data, lesion location, clinical signs, radiographic findings, and treatment options were collected. The included studies reported cases of AF in patients aged between 4 and 21 years. There was a slight male predominance. The most common location of the lesion was the posterior mandible. The most frequent clinical signs were increased bone volume and pain. Radiographically, predominantly multilocular radiolucent lesions were found. The most common treatment was lesion enucleation. No recurrences were observed during the follow-up of the reported cases. The results align with recent literature, providing updated information on the clinical and radiographic profile of AF. Enucleation emerges as an effective treatment option. These findings contribute to accurate diagnosis and appropriate management of patients with AF, highlighting the importance of understanding the clinical characteristics of this neoplasm.

Tratamiento quirúrgico conservador como primera línea de manejo del queratoquiste. Presentación de un caso / Conservative Surgery as First-Line Treatment for Keratocyst: A Case Report / Tratamento cirúrgico conservador como primeira linha de tratamento do queratocisto. Relato de um caso

Introducción: el queratoquiste hace parte de los quistes odontogénicos del desarrollo, derivado de los residuos de la lámina dental con un comportamiento biológico similar al de una neoplasia benigna. Presenta un alto grado de recidiva y agresividad, con lo que ocasiona una destrucción ósea masiva. Puede aparecer en cualquier zona de los maxilares y estar relacionado con dientes retenidos. Imagenológicamente, presenta una lesión radiolúcida multilocular o poliquística, que muestra un borde cortical delgado. Objetivos: demostrar la importancia de un diagnóstico correcto, una detección temprana y acertada, así como inferir la necesidad de utilizar la solución de Carnoy como primera línea de tratamiento, y determinar el momento oportuno para hacerlo. Presentación de caso: hombre de 34 años de edad, sin antecedentes personales relevantes. Tres años atrás había presentado una lesión radiolúcida localizada en los órganos dentarios 34 y 35, motivo por el que le realizaron endodoncia de estos y le removieron la lesión. Ocho meses después, en la tomografía Cone Beam, se evidenció una lesión hipodensa de mayor tamaño que las iniciales en la hemiarcada inferior izquierda. Conclusión: la marsupialización, enucleación más adyuvancia, así como la correcta evaluación de las características clínicas, radiográficas e histopatológicas, permitieron que se llevara a cabo un tratamiento quirúrgico más conservador sin utilizar la solución de Carnoy. Aun así, siempre se recomienda un seguimiento postoperatorio a largo plazo. Por otra parte, no se descarta el uso de solución de Carnoy en casos aislados y según el criterio del operador

Introduction: Keratocyst is a developmental odontogenic cyst originating from dental lamina residues. Its biological behavior is similar to that of a benign neoplasm. Furthermore, it is aggressive and has a high recurrence rate, causing massive bone destruction. It can appear in any area of the jaw and is associated with impacted teeth. On imaging, it appears as a multilocular or polycystic radiolucent lesion with a thin cortical border. Objective: To show the importance of a precise diagnosis, an early and accurate detection, and to determine the use and appropriate time of the application of Carnoy's solution as first-line treatment. Case presentation: A 34-year-old man, with no relevant personal history, who 3 years ago presented with a radiolucent lesion located at the level of teeth 34 and 35. He under- went endodontic treatment and lesion removal. Approximately 8 months later, cone-beam computed tomography revealed a hypodense lesion larger than the initial lesion at the level of the lower left hemi- arch. Conclusion: Marsupialization; enucleation along with adjuvant therapy; and correct evaluation of clinical, radiographic, and histopathological characteristics enabled a conservative surgical treatment to be performed without using Carnoy's solution; nevertheless, postoperative follow-up is recommended. However, in the long term, the use of Carnoy's solution is not eliminated in isolated cases and will be based on the operator's criteria.

Introdução: o queratocisto faz parte dos cistos odontogênicos de desenvolvimento, derivados dos resíduos da lâmina dentária com comportamento biológico semelhante ao de uma neoplasia benigna. Apresenta alto grau de recidiva e agressividade, causando destruição óssea maciça. Pode aparecer em qualquer área dos maxilares, e estar relacionado a dentes retidos. Por meio de análise de imagem, apresenta uma lesão radiolúcida multilocular ou policística que mostra uma borda cortical fina. Objetivo: demonstrar a importância de um diagnóstico correto, uma detecção precoce e correta, bem como inferir a necessidade de usar a solução de Carnoy como primeira linha de tratamento e determinar o momento oportuno para fazê-lo. Apresentação do caso: paciente do sexo masculino, 34 anos, sem antecedentes pessoais relevantes, apresentou há 3 anos uma lesão radiolúcida localizada ao nível dos órgãos dentários 34 e 35, pelo que foi realizada endodontia nos mesmos e retirada da lesão. Depois de 8 meses, a tomografia Cone Beam revelou uma lesão hipodensa maior que as iniciais ao nível da hemiarcada inferior esquerda. Conclusão: a marsupialização, enucleação mais adjuvante, bem como a correta avaliação das características clínicas, radiográficas e histopatológicas permitiram a realização de um tratamento cirúrgico mais conservador sem o uso da solução de Carnoy, mesmo assim, um acompanhamento pós-operatório é sempre recomendado. Já a longo prazo, não está descartada a utilização da solução de Carnoy em casos isolados e a critério do cirurgião

Quiste dentígero en relación con tercer molar inferior retenido

Introducción: El quiste dentígero es un quiste odontogénico, casi siempre asociado a la corona de un diente retenido. Sus ubicaciones más frecuentes son la zona de tercer molar inferior y canino superior. Objetivo: Caracterizar la presentación de un quiste dentígero en un paciente adulto. Presentación de caso: Se presentó el caso de una paciente de 27 años de edad que acude a consulta por presentar sensación de opresión, dolor e inflamación en región de tercer molar inferior izquierdo. Al examen oral se observa tejido dentario en correspondencia con molar 38 parcialmente brotado con ligero edema de la mucosa a su alrededor. En radiografía panorámica se observa imagen radiolúcida en relación con cara mesial del 38 con discreto halo radiopaco, redondeada, compatible con un quiste dentígero. Conclusiones: Un diagnóstico a tiempo de estas lesiones constituye la clave para un tratamiento exitoso y menos invasivo, lo cual evitaría complicaciones mayores como la malignización, el crecimiento exagerado que puede ocasionar deformidad facial y la disfunción masticatoria permanente.

Introduction: Dentigerous cyst is an odontogenic cyst, almost always associated with the crown of a retained tooth. Its most frequent locations are the areas of the lower third molar and the upper canine. Objective: To characterize the presentation of a dentigerous cyst in an adult patient. Case presentation: The case is presented of a 27-year-old female patient who came to the clinic with a sensation of pressure, pain and inflammation in the region of the lower left third molar. Oral examination permits to observe some dental tissue corresponding with molar 38 partially erupted with slight edema of the surrounding mucosa. Panoramic radiograph shows a radiolucent image related to the mesial side of 38, with a discrete radiopaque halo, rounded, compatible with a dentigerous cyst. Conclusions: A timely diagnosis of these lesions is the key to a successful and less invasive treatment, which would avoid major complications, such as malignization, the exaggerated growth that can cause facial deformity and permanent masticatory dysfunction.

Conservative treatment of ameloblastoma: report of 2 cases and review of the literature

Introduction: ameloblastomas correspond to one of the most prevalent odontogenic tumors in developing countries, they are mainly located in the mandible, and their treatment has been widely discussed over the years, using radical or conservative treatments depending on different variables. Clinical case: we present two cases of patients with ameloblastoma who underwent conservative treatment without the use of adjuvant therapy, obtaining satisfactory results at 36 and 48 months. Discussion: due to a possible recurrence with conservative treatment, radical management has been suggested, however, the choice of treatment should be based on a series of clinical, histological, and radiographic characteristics.

Introducción: Los ameloblastomas corresponden a uno de los tumores odontogénicos más prevalentes en los países en desarrollo, se ubican principalmente en la mandíbula, y su tratamiento ha sido ampliamente discutido a lo largo de los años, utilizando tratamientos radicales o conservadores dependiendo de distintas variables. Caso clínico: se presentan dos casos de pacientes con un ameloblastoma a quienes se les realizó tratamiento conservador sin uso de terapia coadyuvante, obteniendo resultados satisfactorios a los 36 y 48 meses. Discusión: Debido a una posible recurrencia con un tratamiento conservador, se ha sugerido manejo radical, sin embargo, la elección de tratamiento debe ser en base a una serie de características clínicas, histológicas y radiográficas.

Queratocisto odontogênico em maxila: relato de caso

Objetivo: Relatar o processo de diagnóstico e tratamento de um queratocisto odontogênico (QO) em seio maxilar e a sua importância na investigação e diagnóstico de Síndrome de Gorlin-Goltz (SGG). Relato de caso: Paciente do gênero feminino, 20 anos, apresentou-se no serviço de odontologia encaminhada pela equipe de genética médica para investigar a presença de QO para definição de diagnóstico de SGG. Foi realizada radiografia panorâmica e verificou-se a presença de alterações no trabeculado ósseo em tuberosidade maxilar do lado esquerdo. Por isso, foi solicitada a tomografia computadorizada de seios maxilares e encontrou-se uma lesão bem delimitada, ocupando quase completamente o seio maxilar esquerdo em íntimo contato com a raiz do dente 27. Portanto, foi realizada biópsia incisional da lesão, acompanhada da aspiração do conteúdo. Na aspiração foi obtido um conteúdo de característica caseosa sugestivo de queratina. O laudo histopatológico da lesão foi de cisto odontogênico. Com isso, foram realizados os procedimentos de exodontia do dente 27 e a enucleação da lesão em seio maxilar pela equipe da odontologia e da otorrinolaringologia, respectivamente, em centro cirúrgico. O laudo histopatológico confirmou a presença de QO, assim foi possível confirmar o diagnóstico da SGG pela equipe da genética médica. A paciente não apresentou sinais de recidiva e nem de novos QO após 2 anos do procedimento. Considerações finais: A SGG requer atenção odontológica especial, visto a alta taxa de QO nos pacientes com essa síndrome. Exame odontológico minucioso envolvendo exame clínico e exames radiográficos devem ser realizado nas consultas de seguimento.

Objective: To report the process of diagnosis and treatment of an odontogenic keratocyst (OK) in the maxillary sinus and its importance in the investigation and diagnosis of Gorlin-Goltz Syndrome (GGS). Case report: A 20-year-old female patient presented at the Dentistry and Stomatology service, referred by the Medical Genetics team to investigate the presence of OK to define the diagnosis of GGS. Panoramic radiography was performed and the presence of alterations in the bone trabeculae in the maxillary tuberosity on the left side was verified. For this reason, computed tomography of the maxillary sinuses was also requested and a well-defined lesion was found, occupying almost completely the left maxillary sinus in close contact with the root of tooth 27. Therefore, an incisional biopsy of the lesion was performed, accompanied by puncture of the same. In the puncture, a characteristic caseous content suggestive of keratin was obtained. The histopathological report of the lesion was described by the pathologist as an odontogenic cyst. With this, tooth extraction procedures for tooth 27 and enucleation of the lesion in the maxillary sinus were carried out by the dentistry and otorhinolaryngology teams, respectively, in a surgical center. The histopathological report confirmed the presence of OK, so it was possible to confirm the diagnosis of GGS by the medical genetics team. The patient showed no signs of recurrence or new OK after 2 years of the procedure. Final considerations: GGS requires special dental attention, given the high rate of OK in patients with this syndrome. A thorough dental examination involving clinical examination and radiographic examinations should be performed at follow-up visits.

Quiste odontogénico ortoqueratinizado. A propósito de un caso

El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.

The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.

Quiste odontogénico ortoqueratinizado. A propósito de un caso / Orthokeratinized odontogenic cyst. A case report

El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.

The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.

Imunoexpressão de clic4, α-sma, e-caderina e vimentina em lesões odontogênicas epitelias benígnas / Immunoexpression of clic4, α-sma, e-cadherin and vimentin in benign epithelial odontogenic lesions

As lesões odontogênicas epiteliais benignas constituem um grupo heterogêneo de lesões. A proteína CLIC4 atua na regulação dos processos de parada de crescimento e apoptose, participando também do processo de transdiferenciação dos fibroblastos em miofibroblastos que passam a expressar α-SMA. Além disso, a expressão de CLIC4 pode interferir no processo de transição epitélio-mesenquima (TEM) em neoplasias. Este trabalho avaliou a imunoexpressão de CLIC4, α-SMA, E-caderina e Vimentina em ameloblastomas (AM) (n = 16), ceratocistos odontogênicos (n = 20) e tumores odontogênicos adenomatóides (TOA) (n = 8). A análise da expressão imunoistoquímica das proteínas CLIC4, E-caderina e vimentina no componente epitelial das lesões e de CLIC4 e α-SMA no tecido conjuntivo foi realizada de forma semi-quantitativa por um avaliador previamente calibrado. A expressão no componente epitelial de CLIC4 foi analisada separadamente no núcleo e no citoplasma, bem como a marcação de E-caderina que foi avaliada na membrana e no citoplasma. As comparações dos percentuais de imunorreatividade em relação aos grupos estudados foram realizadas por meio dos testes não paramétricos de Kruskal-Wallis e Mann-Whitney. Possíveis correlações entre a expressão de CLIC4, α-SMA, E-caderina e Vimentina foram avaliadas por meio do teste de correlação de Spearman. O nível de significância foi estabelecido em 5% (p < 0,05). Foram observados diferentes padrões de marcação entre os grupos analisados, observando-se que a imunoexpressão exclusivamente citoplasmática da CLIC4 no componente epitelial dos AM (p < 0,001) e TOA (p < 0,001) foi significativamente superior a dos CO, não demonstrarando significância estatística entre os AM e TOA. A imunoexpressão (nuclear e citoplasmática) da CLIC4 no revestimento epitelial CO foi significativamente superior à encontrada no componente epitelial dos AM (p < 0,001) e dos TOA (p < 0,001). A imunoexpressão estromal de CLIC4 foi significativamente superior nos AM (p = 0,009) e CO (p = 0,004) quando comparados aos TOA. A imunoexpressao de α-SMA significativamente maior em AM (p = 0,016) e CO (p = 0,034) quando comparados aos TOA. Para a imunoexpressão membranar da E-caderina em CO foi significativamente superior em comparação à encontrada nos AM (p = 0,009) e nos TOA (p = 0,024). Foi observada maior imunoexpressão de E-caderina (membranar e citoplasmática) nos COs, quando comparados aos AM (p < 0,001) e aos TOAs (p < 0,001). A expressão de Ecaderina citoplasmática foi significativamente maior nos AM e TOA (p < 0,001) quando comparados aos CO. Observou-se diferença estatisticamente significativa na imunoexpressão de vimentina entre os casos de AM e os casos de TOA (p = 0,038) e CO (p < 0,001), bem como entre o TOA e CO (p < 0,001). As correlações testadas entre os escores das proteínas estudadas evidenciou que no grupo dos AM foi possível evidenciar moderada correlação positiva e estatisticamente significativa (r = 0,527; p = 0,036) entre a expressão citoplasmática da CLIC4 e a expressão citoplasmática da E-caderina. Também foi verificada fraca correlação negativa e estatisticamente significativa (r = -0,499; p = 0,049) entre a expressão núcleo-citoplasmática da CLIC4 e a expressão citoplasmática da E-caderina nos AM. Além disso, uma moderada correlação positiva e estatisticamente significativa entre a expressão estromal da CLIC4 e a expressão da α-SMA nos AM (r = 0,648; p = 0,007) e nos CO (r = 0,541; p = 0,014). Foi observada forte correlação negativa e estatisticamente significativa (r = -0,813; p < 0,001) entre a expressão da E-caderina e a expressão da vimentina nos AM. Os resultados deste estudo sugerem um potencial envolvimento de CLIC4 no processo de transdiferenciação de miofibroblastos, e que a presença destas células é mais frequentemente associada a lesões de comportamento biológico mais agressivo como os AM e CO, além de uma possível atuação desta proteína na regulação do ciclo celular e na TEM nas lesões estudadas (AU).

Benign epithelial odontogenic lesions constitute a heterogeneous group of lesions. the CLIC4 protein acts in the regulation of growth arrest and apoptosis processes, also participating in the process of transdifferentiation of fibroblasts Into myofibroblasts that begin to express α-SMA. Furthermore, CLIC4 expression can interfere with the epithelialmesenchymal transition (EMT) process in neoplasms. This work evaluated the immunoexpression of CLIC4, α-SMA, e-cadherin and vimentin in ameloblastomas (AM) (n = 16), odontogenic keratocysts (OK) (n = 20) and adenomatoid odontogenic tumors (AOT) (n = 8). The analysis of the immunohistochemical expression of the proteins CLIC4, ecadherin and vimentin in the epithelial component of the lesions and of CLIC4 and α-SMA in the connective tissue was carried out in a semi-quantitative way by a previously calibrated evaluator. Expression in the epithelial component of CLIC4 was analyzed separately in the nucleus and cytoplasm, as well as e-cadherin labeling, which was evaluated in the membrane and cytoplasm. Comparisons of the percentages of immunoreactivity in relation to the studied groups were carried out using the nonparametric kruskal-wallis and mann-whitney tests. Possible correlations between the expression of CLIC4, α-SMA, e-cadherin and vimentin were evaluated using the spearman correlation test. The significance level was set at 5% (p < 0.05). Different staining patterns were observed between the groups analyzed, observing that the exclusively cytoplasmic immunoexpression of CLIC4 in the epithelial component of AM (p < 0.001) and AOT (p < 0.001) was significantly higher than that of OK, not demonstrating statistical significance between the AM and AOT. The immunoexpression (nuclear and cytoplasmic) of CLIC4 in the co epithelial lining was significantly higher than that found in the epithelial component of AM (p < 0.001) and AOT (p < 0.001). Stromal CLIC4 immunoexpression was significantly higher in AM (p = 0.009) and OK (p = 0.004) when compared to AOT. The immunoexpression of α-SMA is significantly higher in AM (p = 0.016) and OK (p = 0.034) when compared to AOT. For e-cadherin membrane immunoexpression in co was significantly higher compared to that found in AM (p = 0.009) and AOT (p = 0.024). Greater immunoexpression of e-cadherin (membrane and cytoplasmic) was observed in OK, when compared to AM (p < 0.001) and AOT (p < 0.001). Cytoplasmic ecadherin expression was significantly higher in AM and AOT (p < 0.001) when compared to OK. A statistically significant difference in vimentin immunoexpression was observed between cases of AM and cases of AOT (p = 0.038) and OK (p < 0.001), as well as between AOT and OK (p < 0.001). The correlations tested between the scores of the proteins studied showed that in the am group it was possible to demonstrate a moderate positive and statistically significant correlation (r = 0.527; p = 0.036) between the cytoplasmic expression of clic4 and the cytoplasmic expression of e-cadherin. A weak and statistically significant negative correlation (r = -0.499; p = 0.049) was also found between the nucleus-cytoplasmic expression of clic4 and the cytoplasmic expression of e- cadherin in AM. Furthermore, a moderate positive and statistically significant correlation between the stromal expression of CLIC4 and the expression of α-SMA in AM (r = 0.648; p = 0.007) and OK (r = 0.541; p = 0.014). Additionally, a strong negative and statistically significant correlation (r = -0.813; p < 0.001) was observed between the expression of ecadherin and the expression of vimentin in AM. The results of this study suggest a potential involvement of CLIC4 in the myofibroblast transdifferentiation process, and that the presence of these cells is more frequently associated with lesions with more aggressive biological behavior such as AM and OK, in addition to a possible role of this protein in the regulation of cell cycle and EMT in the lesions studied (AU).

Peripheral squamous odontogenic tumor associated with an impacted mandibular third molar: A case report

Introduction: Squamous odontogenic tumor is a benign but locally infiltrative, epithelial odontogenic tumor. This case report presents a case of a peripheral variant of squamous odontogenic tumor. Case Presentation: A 29-year-old male patient presented with pain in the left posterior mandible region for one month. Radiographic examination revealed an impacted left mandibular third molar with no other abnormalities. Management and Prognosis: The impacted tooth was removed under local anaesthesia. Histopathological examination of the abnormally thick pericoronal tissue, covering the impacted tooth revealed islands of bland squamous epithelium in a background of mature fibrous connective tissue. The prognosis was good with no signs of recurrence after one year of follow- up. Conclusion: Squamous odontogenic tumor should be considered in the differential diagnosis of pericoronal pathoses, although it is rare in this location.

Case Analysis and Systematic Review of Aspergilloma

Introduction: Aspergillus fumigatus is the most prevalent fungal pathogen reported to cause diseases such as aspergilloma or aspergillosis in humans. Aspergillomas are commonly seen in a poorly drained and avascular cavitary space. Paranasal sinuses are most commonly involved, especially maxillary sinus. In the past two decades, the incidence of aspergillosis has increased substantially. Aims: To evaluate cases reported as aspergilloma of the maxillary sinus and to determine the percentage of cases involving aspergilloma of the maxillary sinus in healthy individuals. Materials and Methods: After the final full-text review,16 articles were included in this systematic review. Data extracted from these full-text articles was reviewed. Results: 83 % of cases had a history of dental procedures, with 42 % of those being due to infection from previous extraction sockets and 41 % due to root canal therapy (RCT). About 43% of the patients were immunocompromised, while 56% were healthy without any predisposing conditions. Conclusion: Aspergillus fungal infections of the paranasal sinuses are common and can occur in apparently healthy as well as immunocompromised individuals. Aspergilloma is the most common fungal infection involving the maxillary sinus with iatrogenic-dentogenic factors being predominant for initiation and progression of the infection. About 43% of the patients in this review were immunocompromised patients whereas 56% of the patients were healthy without any known predisposing condi- tions. The progression and prognosis of this disease depends on the location and immunologic status of the patient. So, it is very important for dentists to be cautious while performing any dental procedures so as not to initiate any iatrogenic infections.

Lesiones cervicofaciales tumorales y pseudotumorales pediátricas en Villa Clara. Años 2010-2019 / Pediatric tumoral and pseudotumoral cervicofacial lesions in Villa Clara from 2010 to 2019

Caracterizar las lesiones cervicofaciales tumorales y pseudotumorales en niños en Villa Clara es una necesidad creciente por las alteraciones físicas, estéticas y psicológicas que pueden ocasionar. Se realizó un estudio transversal y descriptivo en el Servicio de Cirugía Maxilofacial Pediátrico de esta provincia, en el período 2010-2019. La población estuvo constituida por 101 niños con estudio histológico concluyente de lesión tumoral benigna, maligna o pseudotumoral de la región cervicofacial. Se concluyó que los tumores y pseudotumores en la región cervicofacial no tuvieron relación con la edad, género, ni color de la piel, en los niños estudiados. En esta serie predominaron los tumores benignos. El tumor maligno de mayor prevalencia fue el Linfoma de Burkitt. Existió alta correlación entre los diagnósticos clínico e histológico.

Characterizing tumoral and pseudotumoral cervicofacial lesions in children in Villa Clara is a growing need due to the physical, aesthetic and psychological alterations that they can cause. A cross-sectional and descriptive study was carried out in the pediatric maxillofacial surgery service of this province from 2010 to 2019. The population consisted of 101 children with conclusive histological study of benign and malignant tumoral or pseudotumoral lesions of the cervicofacial region. We concluded that tumors and pseudotumors in the cervicofacial region were not related to age, gender or skin color in the studied children. In this series, benign tumors predominated. The most prevalent malignant tumor was Burkitt's lymphoma. There was a high correlation between clinical and histological diagnoses.

Reconstruction Plate Fracture: Mechanism and Recent Advances

Reconstruction plates with or without bone grafts are used to restore mandibular continuity, form and function following segmental resection of mandible. Fracture of reconstruction plate is observed in 2.9 % to 10% of cases reported in the literature excluding other complications. In this case, we report the fracture of stainless steel reconstruction plate used without bone graft and its management using locking reconstruction plate with non vascularised iliac crest graft following removal of the fractured plate. Review of literature describing incidence, pattern and causes of reconstruction plate fracture and its management is discussed.

Manejo de quiste odontogénico glandular con rehabilitación implantológica guiada. Reporte de un caso / Management of glandular odontogenic cyst with guided implantologic rehabilitation. Case report

Resumen Objetivo: Describir el manejo de un caso de quiste odontogénico glandular, con tratamiento conservador, terapias adyuvantes y rehabilitación implantoasistida a los 7 años de seguimiento. Caso clínico: Se presenta un caso clínico de un paciente masculino con una lesión mandibular con diagnóstico de quiste odontogénico glandular. El tratamiento que se realizó fue una enucleación con tratamiento de superficie con solución de Carnoy y ostectomía periférica. Se realizó seguimiento clínico y radiográfico durante 7 años verificando ausencia de recidiva, momento en cual se realizó mediante planificación virtual la colocación de implantes con guías quirúrgicas de precisión para rehabilitación implanto asistida.

Abstract Aim: To describe the management of a case with a glandular odontogenic cyst, treated with a conservative treatment, adyuvant therapy and guided implantologic rehabilitation at 7 years of follow up. Clinical case: A case report of a male patient with a mandibular lesion with a diagnose of glandular odontogenic cyst is presented. The treatment that was performed was an enucleation with surface treatment with Carnoy's solution and peripheral ostectomy. Clinical and radiographic follow up was carried out for 7 years, verifying the absence of recurrence. At that time, it was done placement of implants with virtual planning and precision surgical guides for implant-assisted rehabilitation.

Cementoblastoma asociado a primer molar permanente. Reporte de un caso / Cementoblastoma associated with a first permanent molar. A case report

Resumen Objetivo: El cementoblastoma es una neoplasia odontogénica benigna de origen mesenquimático relativamente poco frecuente que se asocia a las raíces de las piezas dentarias. Se considera que es la única neoplasia verdadera de origen cemental. El objetivo del presente trabajo es describir el caso clínico de un cementoblastoma de grandes dimensiones y realizar una revisión bibliográfica a fin de establecer pautas de diagnóstico y tratamiento, señalando sus diferenciales con patologías de similares características como la displasia cemento ósea y el fibroma cemento osificante. Caso clínico: Se describe el caso de un paciente pediátrico que presenta un aumento de volumen de considerables dimensiones asociado al primer molar permanente mandibular. Teniendo en cuenta las características clínicas y radiográficas, y con un diagnóstico presuntivo de cementoblastoma, se realizó la extirpación quirúrgica de la lesión junto con la pieza dentaria asociada, confirmándose el diagnóstico inicial por medio del estudio anatomopatológico.

Abstract Aim: Cementoblastoma is a relatively infrequent benign odontogenic neoplasia of mesenchymal origin that is associated with the roots of teeth. It is considered to be the only true cemental originated neoplasm. The objective of this article is to describe the clinical case of a large cementoblastoma and to carry out a bibliographical review to establish diagnostic and treatment guidelines, pointing out its differences with pathologies of similar characteristics, such as the cemento-osseous dysplasia and the cemento-ossifying fibroma. Clinical case: The case of a pediatric patient who presents a considerable increase in the volume associated with the mandibular first permanent molar is described. Considering the clinical and radiographic characteristics, and with a presumptive diagnosis of cementoblastoma, a surgical extraction of the lesion along with the associated tooth was performed, confirming the initial diagnosis by an anatomopathological study.

Análise imuno-histoquímica da Yes-Associated Protein (YAP) e sua influência sobre a proliferação celular e a apoptose em lesões odontogênicas epiteliais benignas / Immunohistochemical analysis of Yes-Associated Protein (YAP) and its influence on cell proliferation and apoptosis in benign epithelial odontogenic lesions

Introdução: Os cistos e tumores odontogênicos são lesões que apresentam comportamento biológico heterogêneo e patogênese ainda não totalmente esclarecida. A Yes-associated protein (YAP) atua como um regulador transcricional de genes envolvidos na proliferação celular e na apoptose, participando da ativação de vias associadas ao crescimento cístico e à progressão neoplásica. Objetivo: Analisar a expressão imuno-histoquímica da proteína YAP e correlacioná-la com marcadores envolvidos na proliferação celular e na apoptose em lesões odontogênicas epiteliais benignas. Metodologia: A amostra consistiu de 95 casos de lesões odontogênicas - 25 cistos dentígeros (CDs), 30 CO não sindrômicos (COs), 30 AMB convencionais (AMB-Cs) e 10 AMB unicísticos (AMB-Us) -, além de 10 espécimes de folículo dentários (FD). Foi realizada coleta dos dados clinico-demográficos dos casos, bem como análise morfológica para melhor caracterização da amostra. Os cortes histológicos foram submetidos à técnica imuno-histoquímica através da utilização dos anticorpos YAP, ciclina D1, Ki-67 e Bcl-2, e a análise da expressão destes foi realizada quali-quantitativamente, mediante metodologia adaptada. Os dados coletados seguiram para análise descritiva e estatística (p ≤ 0,05). Resultados: Houve discreta predileção por mulheres (n = 55; 57,6%) e por indivíduos na faixa etária dos 21 aos 40 anos (n = 50; 47,6%), sendo a região posterior de mandíbula mais afetada (64%). A análise da imunoexpressão de YAP revelou maiores níveis de expressão em COs, especialmente nas camadas basal e parabasal, seguido dos AMB-Us e AMB-Cs, que demonstraram moderada imunorreatividade, predominantemente nas células periféricas. Além disso, houve diferenças significativas quanto à imunoexpressão de YAP entre os grupos analisados, com existência de correlações positivas e estatisticamente significativas entre YAP e ciclina D1 em CDs e AMB-Us, e entre YAP e Ki-67 em AMB-Us (p < 0,05). Todavia, entre a imunoexpressão YAP e Bcl-2, foi verificada ausência de correlação estatisticamente significativa. Conclusões: A YAP pode exercer influência sobre a proliferação celular do epitélio de cistos e tumores odontogênicos, auxiliando, assim, na progressão das diferentes lesões odontogênicas (AU).

Background: Odontogenic cysts and tumors present heterogeneous biological behavior, and their etiopathogenesis is not fully understood yet. Yes-associated protein (YAP) acts as a transcriptional regulator of genes involved in cell proliferation and apoptosis, activating pathways associated with cystic growth and neoplastic progression. Objective: To analyze the immunohistochemical expression of YAP protein and correlate it with markers involved in cell proliferation and apoptosis in benign epithelial odontogenic lesions. Methods: The sample consisted of 95 cases of odontogenic lesions - 25 dentigerous cysts (DCs), 30 non-syndromic odontogenic keratocyst (OKCs), 30 conventional AMB (C-AMBs), and 10 unicystic AMB (UAMBs) -, in addition to 10 specimens of dental follicles (DF). Clinicodemographic data collection was carried out, as well as morphological analysis for better characterization of the sample. The histological sections were submitted to the immunohistochemical technique using YAP, cyclin D1, Ki-67, and Bcl-2 antibodies, and their immunoexpression analysis was performed qualitatively and quantitatively, through an adapted methodology. The collected data were submitted for descriptive and statistical analysis (p ≤ 0.05). Results: There was a slight predilection for women (n = 55; 57.6%) and individuals aged between 21 and 40 years (n = 50; 47.6%), with the posterior region of the mandible as the most affected site (64%). Analysis of YAP immunoexpression revealed higher expression levels in OKCs, especially in the basal and parabasal layers, followed by U-AMBs and C-AMBs, which showed moderate immunoreactivity, predominantly in peripheral cells. In addition, there were significant differences in YAP immunoexpression between the analyzed groups, with positive and statistically significant correlations between YAP and cyclin D1 in DCs and U-AMBs, and between YAP and Ki-67 in U-AMBs (p < 0.05). However, between YAP and Bcl-2 immunoexpression, there was no statistically significant correlation. Conclusions: YAP may influence on the cell proliferation of odontogenic cysts and tumors epithelium, thus helping with the progression of the different odontogenic lesions (AU) .

Immunohistochemistry in oral and maxillofacial pathology: The role and rational use of antibodies in the diagnosis of surgical lesions / Inmunohistoquímica en patología oral y maxilofacial: El rol y uso racional de anticuerpos en el diagnóstico de lesiones quirúrgicas

Background:Immunohistochemistry have had a huge impact on oral and maxillofacial pathology diagnosis. As a method it determines distribution and amount of certain cellular molecules via specific antigen-antibody reaction. Whereas in most cases a definitive diagnosis is achieved based on detailed hematoxylin and eosin cytomorphological analysis, along with clinical and radiological features, some challenging and equivocal neoplasms need to be further assessed with immunohistochemistry. Objective:This article reviews and updates immunohistochemistry technique fundamentals, its role and relevance in the diagnosis of common oral and maxillofacial lesions encountered in daily practice. Materials and methods: A literature review on the topic was carried out by searching pertinent and available papers on PubMed, ClinicalKey and Scielo platforms with no date restriction, up to 2022. Conclusion: Immunohistochemistry is an important tool that has been integrated into conventional histopathology and provides diagnostic assistance in the interpretation of common but equivocal neoplasms

Antecedentes: El uso de la inmunohistoquímica ha tenido un gran impacto en el diagnóstico de patología oral y maxilofacial. Como técnica, determina la distribución y la cantidad de ciertas moléculas celulares a través de una reacción antígeno-anticuerpo específica. Aunque en la mayoría de los casos se logra obtener un diagnóstico definitivo basado en el análisis cito morfológico con hematoxilina y eosina, junto con las características clínicas y radiológicas, algunas neoplasias microscópicamente equívocas deben evaluarsemás a fondo con inmunohistoquímica. Objetivo: Este artículo revisa los fundamentos básicos actuales de la técnica y su relevancia en el diagnóstico de algunas lesiones orales y maxilofaciales frecuentemente tratadas en la práctica clínica diaria. Materiales y Métodos: Se realizó una búsqueda y revisión de artículos científicos relacionados con el uso immunohistoquímica en patología oral y maxilofacial en PubMed, ClinicalKey y Scielo. Conclusión: La immunohistoquimica es una herramienta importante que ha sido integrada a la histopatología convencional y brinda asistencia diagnostica en la interpretación de neoplasias comunes pero equívocas