Etiopatogenia e tratamento da osteonecrose dos maxilares induzida por medicamentos: aspectos essenciais ao dentista / Etiopathogenesis and treatment of medication-related osteonecrosis of the jaw: essential aspects for the dentist

A osteonecrose dos maxilares induzida por medicamentos (MRONJ) caracteriza-se por exposição óssea ou osso que pode ser sondado através de fístula intra ou extraoral, em região maxilofacial, e que não cicatriza dentro de oito semanas. A MRONJ é uma condição rara e debilitante que pode causar dor, disfagia e odor desagradável na cavidade oral, afetando pacientes com histórico ou sob uso contínuo de terapia antirreabsortiva, isolada ou associada a imunomoduladores ou drogas antiangiogênicas, mas sem histórico de radioterapia nos maxilares. O objetivo desta revisão narrativa de literatura é compilar os principais aspectos sobre a etiopatogenia da MRONJ e as opções terapêuticas disponíveis. A etiologia da MRONJ é multifatorial, complexa, e não está totalmente compreendida, não havendo um tratamento definitivo, mas diversas modalidades terapêuticas que visam o controle da dor e da progressão da osteonecrose. Conclui-se com essa revisão que o entendimento da etiopatogenia da MRONJ pelo cirurgião-dentista lhe permite adotar medidas preventivas, bem como o conhecimento das modalidades terapêuticas disponíveis lhe possibilita oferecer o manejo adequado para seu paciente, conforme o estágio da doença.

Medication-related osteonecrosis of the jaw (MRONJ) is characterized by exposed bone or bone that can be probed through an intra or extraoral fistula, in the maxillofacial region, which does not heal within eight weeks. MRONJ is a rare and debilitating condition that can cause pain, dysphagia and unpleasant odor in the oral cavity, affecting patients with a history or continuous use of antiresorptive therapy, alone or associated with immunomodulators or antiangiogenic drugs, but without a history of radiotherapy to the jaws. The aim of this narrative literature review is to compile the main aspects about the etiopathogenesis of MRONJ and the available therapeutic options. The etiology of MRONJ is multifactorial, complex, and is not fully understood, with no definitive treatment, but several therapeutic modalities that aim to control pain and the progression of osteonecrosis. It is concluded from this review that the understanding of the etiopathogenesis of MRONJ by the dental surgeon allows him to adopt preventive measures, as well as the knowledge of the therapeutic modalities available allows him to offer the appropriate management for his patient, depending on the stage of the disease.

Hemi-craneotomía y hemimandibulectomía izquierda como tratamiento del ameloblastoma multiquístico, manejo multidisciplinario. Reporte de caso / Left hemi-craneotomy and hemimandibulectomy as treatment of multicystic ameloblastoma, multidisciplinary management. Case report

El ameloblastoma multiquístico, una neoplasia odontogénica de crecimiento lento, pero comportamiento agresivo, suele manifestarse en la mandíbula, generando deformidades faciales, pérdida dentaria y desplazamiento de tejidos adyacentes. Este estudio tiene como objetivo describir el tratamiento quirúrgico multidisciplinario del ameloblastoma multiquístico en una localización inusual, destacando el compromiso de estructuras vitales y los estudios complementarios necesarios para un diagnóstico preciso. Se presenta el caso de un paciente masculino con una lesión en la hemicara izquierda, que se había desarrollado durante aproximadamente ocho meses, abarcando desde la región temporoparietal hasta la región maseterina ipsilateral. La evaluación clínica y radiológica inicial sugirió la posibilidad de un ameloblastoma multiquístico, confirmado posteriormente mediante biopsia. Como parte del equipo multidisciplinario del Hospital San Vicente Fundación de Medellín, se optó por una resección quirúrgica radical, que incluyó hemi-craneotomía y hemi-mandibulectomía, seguida de una reconstrucción exitosa. Se señala la importancia de un abordaje coordinado entre cirujanos maxilofaciales, estomatólogos y otros especialistas, así como la relevancia de los estudios complementarios para determinar el curso terapéutico óptimo. La cirugía reconstructiva demostró ser efectiva tanto en la restauración funcional como estética, aunque destaca los desafíos inherentes a la gestión de localizaciones poco comunes de esta enfermedad.

Multicystic ameloblastoma, a slow-growing but aggressive odontogenic neoplasm, usually manifests in the mandible, causing facial deformities, tooth loss and displacement of adjacent tissues. This study aims to describe the multidisciplinary surgical management of multicystic ameloblastoma in an unusual location, highlighting the involvement of vital structures and the complementary studies necessary for an accurate diagnosis. We present the case of a male patient with a lesion in the left hemiface, which had developed over approximately eight months, spanning from the temporoparietal region to the ipsilateral maseterine region. Initial clinical and radiological evaluation suggested the possibility of multicystic ameloblastoma, subsequently confirmed by biopsy. As part of the multidisciplinary team of the Hospital San Vicente Fundación de Medellín, a radical surgical resection was chosen, including hemi-craniotomy and hemi-mandibulectomy, followed by successful reconstruction. The importance of a coordinated approach between maxillofacial surgeons, stomatologists and other specialists is emphasized, as well as the relevance of complementary studies to determine the optimal therapeutic course. Reconstructive surgery proved to be effective in both functional and cosmetic restoration, although it highlights the challenges inherent in managing rare locations of this disease.

Abordagens cirúrgicas para cisto dentígero: revisão de literatura / Surgical approaches for dentigerous cyst: literature review

O objetivo desta revisão integrativa foi elaborar uma avaliação qualitativa da literatura existente sobre as modalidades de tratamento utilizadas para cistos dentígeros em pacientes pediátricos. O presente estudo trata-se de uma revisão integrativa da literatura na qual utilizou-se as bases de dados PubMed, BVS (Biblioteca Virtual em Saúde), LILACS, e SciELO. Como critérios de inclusão estavam os artigos publicados na íntegra, relatos de caso clínico, revisões sistemáticas e de meta-análise publicados nos últimos 10 anos, disponível nos idiomas português ou inglês, que abordassem a temática. Os critérios de exclusão foram: resumos, anais, editoriais, cartas ao editor, reflexão, duplicidade, artigos com detalhamento incompleto. O cisto dentígero é o tipo mais comum dos cistos odontogênicos de desenvolvimento e o segundo mais frequente entre todos que ocorrem nos maxilares, representando cerca de 20% de todos os cistos revestidos por epitélio nos ossos gnáticos. Clinicamente pode estar associado a qualquer dente impactado, porém ele envolve com mais frequência os terceiros molares inferiores. Acomete pacientes entre 10 a 30 anos de idade, com predileção pelo sexo masculino, sendo na maioria dos casos detectados em exames radiográficos de rotina. O tratamento baseia-se nas técnicas de descompressão, marsupialização e enucleação. O prognóstico para os cistos dentígeros é altamente favorável e não há chance de recorrência após a remoção completa. Assim, a decisão terapêutica deve ser tomada de forma adequada para cada caso, levando em consideração a localização anatômica, extensão clínica, tamanho, idade, remoção do dente não irrompido e possibilidades de acompanhamento.

The aim of this integrative review was to carry out a qualitative assessment of the existing literature on the treatment modalities used for dentigerous cysts in pediatric patients. This study is an integrative literature review using the PubMed, VHL (Virtual Health Library), LILACS and SciELO databases. The inclusion criteria were articles published in full, clinical case reports, systematic reviews and meta-analysis published in the last 10 years, available in Portuguese or English, which addressed the subject. The exclusion criteria were: abstracts, annals, editorials, letters to the editor, reflection, duplication, articles with incomplete details. The dentigerous cyst is the most common type of developmental odontogenic cyst and the second most frequent of all those that occur in the jaws, accounting for around 20% of all epithelium-lined cysts in the gnathic bones. Clinically, it can be associated with any impacted tooth, but it most often involves the lower third molars. It affects patients between 10 and 30 years of age, with a predilection for males, and in most cases it is detected during routine radiographic examinations. Treatment is based on decompression, marsupialization and enucleation. The prognosis for dentigerous cysts is highly favorable and there is no chance of recurrence after complete removal. Therefore, the therapeutic decision must be made appropriately for each case, taking into account the anatomical location, clinical extension, size, age, removal of the unerupted tooth and follow-up possibilities.

Angina bolhosa hemorrágica: uma revisão de literatura / Hemorrhagic angina bullosa: a review of the literature

Introdução: A angina bolhosa hemorrágica (ABH) é uma condição rara caracterizada pelo surgimento súbito de bolhas de sangue nas mucosas orais e orofaringe. Objetivo: Este trabalho tem como propósito fornecer uma análise abrangente das características clínicas, etiológicas e histopatológicas da angina bolhosa hemorrágica, além de abordar métodos de diagnóstico e opções de tratamento. Materiais e métodos: Foi realizada uma busca por artigos científicos publicados de 2010 a 2023, nas bases de dados Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) e ScienceDirect. Foram coletados artigos em inglês e português utilizando as palavras-chave "angina bolhosa hemorrágica", "estomatite bolhosa hemorrágica benigna", "hemorrhagic bullous angina" e "benign hemorrhagic bullous stomatitis". Conclusão: A ABH é escassamente documentada na literatura, com muitos dados ausentes ou subnotificados. Embora seja uma condição benigna com rápida evolução espontânea, o procedimento diagnóstico deve ser rigoroso para descartar outras possíveis lesões.

Introduction: Bullous hemorrhagic angina (ABH) is a rare condition characterized by the sudden appearance of blood blisters on the oral mucosa and oropharynx. Objective: This work aims to provide a comprehensive analysis of the clinical, etiological and histopathological characteristics of hemorrhagic bullous angina, in addition to addressing diagnostic methods and treatment options. Materials and methods: A search was carried out for scientific articles published between 2010 and 2023, in the Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) and ScienceDirect databases. Articles were found in English and Portuguese using the keywords "hemorrhagic bullous angina", "benign herrhagic bullous stomatitis", "hemorrhagic bullous angina" and "benign herrhagic bullous stomatitis". Conclusion: ABH is scarcely documented in the literature, with many data missing or underreported. Although it is a benign condition with rapid spontaneous evolution, the diagnostic procedure must be rigorous to rule out other possible lesions.

Necrotizing sialometaplasia: systematic review and meta analyses over the past 46 years

Objectives: The aim of this study was to characterize the main characteristics of this disease in relation to diagnosis, clinical aspects, progression and treatment as well as correlating them with remission time. Material and Methods: A systematic search was performed following the guidelines given by PRISMA and the Joanna Briggs Institute. PubMed, Web of Science and Scopus were the databases used. Results: The final analysis resulted in 108 articles with 173 clinical cases. The longest remission time for signs and symptoms (>7 weeks) was registered among male patients (p = 0.02) and outside the oral cavity; however no significant correlation was observed (p>0.05). A high risk of bias was the most common rating among the articles analyzed (55%); followed by moderate (27%) and low (18%). The lack of standardization in clinical case report descriptions made it difficult to gain a thorough knowledge of the essential characteristics of the NS patho-logical processes. Conclusion: It is recommended that publications follow the standards recommended by the literature; in addition, studies using advanced technologies to better understand NS's pathological path are recommended so as to propose effective treatments for this disease. (AU)

Recurring basal cell carcinoma involvingexclusively intra-oral mucosa: a case report

Basal cell carcinoma (BCC) is the most common skin cancer, but oral involvement is extremely rare. Here, we showed a case of a 71-year-old Caucasian male patient presenting an asymptomatic submucosal nodule in the left buccal mucosa on the same side of a previous BCC skin lesion. Intraoral examination revealed a circumscribed sessile and fibrous mass covered by normal mucosa. An incisional biopsy was performed. Microscopically, the lesion showed uniform, ovoid, dark-staining basaloid cells with medium-sized nuclei and little cytoplasm arranged in islands and strands, invading the underlying connective tissue. These islands demonstrated palisading of the peripheral cells and occasionally central areas with epidermoid differentiation. The final diagnosis was nodular basal cell carcinoma. Although uncommon, recurrent BCC may occur in the oral cavity. (AU)

Consideraciones bioéticas en el manejo de la esclerosis lateral amiotrófica: Una aproximación al quehacer fonoaudiológico

Introducción: La esclerosis lateral amiotrófica (ELA) es la forma más común de enfermedad degenerativa de motoneurona en la edad adulta y es considerada una enfermedad terminal. Por lo mismo, el accionar del fonoaudiólogo debe considerar el respeto a los principios bioéticos básicos para garantizar una asistencia adecuada. Objetivo: Conocer aquellas consideraciones bioéticas relacionadas al manejo y estudio de personas con ELA para luego brindar una aproximación hacia el quehacer fonoaudiológico. Método: Se efectuó una búsqueda bibliográfica en las bases de datos PubMed, Scopus y SciELO. Se filtraron artículos publicados desde 2000 hasta junio de 2023 y fueron seleccionados aquellos que abordaban algún componente bioético en población con ELA. Resultados: Aspectos relacionados al uso del consentimiento informado y a la toma de decisiones compartidas destacaron como elementos esenciales para apoyar la autonomía de las personas. Conclusión: Una correcta comunicación y una toma de decisiones compartida son claves para respetar la autonomía de las personas. A su vez, la estandarización de procedimientos mediante la investigación clínica permitirá aportar al cumplimiento de los principios bioéticos de beneficencia y no maleficencia, indispensables para la práctica profesional.

Introduction: Amyotrophic lateral sclerosis (ALS) is the most common form of degenerative motor neuron disease in adulthood and is considered a terminal disease. For this reason, the actions of the speech therapist must consider respect for basic bioethical principles to guarantee adequate assistance. Objective: To know those bioethical considerations related to the management and study of people with ALS to then provide an approach to speech therapy. Methodology: A bibliographic search was carried out in the PubMed, Scopus, and SciELO databases. Articles published from 2000 to June 2023 were filtered and those that addressed a bioethical component in the population with ALS were selected. Results: Aspects related to the use of informed consent and shared decision-making stood out as essential elements to support people's autonomy. Conclusion: Proper communication and shared decision-making are key to respecting people's autonomy. In turn, the standardization of procedures through clinical research will contribute to compliance with the bioethical principles of beneficence and non-maleficence, essential for professional practice.

Outcomes of a Community of Practice on Quebec Speech Language Pathologists' Voice Assessment Practices and Professional Identity

In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project's end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.

En un contexto en el que existen diferentes protocolos para las prácticas recomendadas en la evaluación vocal clínica, y en el que se presentan vacíos en la literatura respecto a la base de evidencia que respalda los procedimientos y medidas de evaluación, los profesionales de regiones donde no hay una comunidad sólida con experiencia en prácticas vocales clínicas y científicas pueden enfrentar dificultades para desarrollar con confianza sus prácticas de evaluación vocal. Con el propósito de mejorar las prácticas de evaluación vocal y fortalecer la identidad profesional entre los logopedas de Quebec, Canadá, se estableció una comunidad de práctica (CdP). Esta tenía como objetivo fomentar el intercambio de conocimientos, implementar cambios en la práctica clínica y mejorar la identidad profesional. Un total de treinta y nueve participantes se involucraron en las actividades de la CdP, llevadas a cabo durante un período de cuatro meses, que incluyeron reuniones virtuales y talleres presenciales. Los participantes tuvieron una alta tasa de asistencia (> 74% de participación en las reuniones virtuales) y expresaron un alto grado de satisfacción con su participación, manifestando su intención de continuar involucrados después de la finalización del proyecto. Se observaron cambios estadísticamente significativos en las prácticas de evaluación vocal posterior a la CdP, en lo que respecta a la probabilidad de llevar a cabo evaluaciones (p < .001) y la percepción de la importancia de la evaluación con fines evaluativos (p < .001), así como mejoras en la confianza específica en la evaluación, particularmente en el procedimiento de evaluación auditivo-perceptual (p < .001) y el propósito de la evaluación aerodinámica (p = .05). Además, se registró un aumento en la identidad profesional posterior a la CdP (p < .001) y los participantes sintieron que obtuvieron aprendizajes significativos. El presente estudio destacó la necesidad de involucrar a los logopedas en investigaciones futuras, para identificar evaluaciones pertinentes a los objetivos evaluativos específicos de los logopedas que trabajan con la voz, y sugiere que las CdP son una herramienta eficiente con ese propósito.

Factores asociados a cesárea en usuarias de una clínica privada en Chile, años 2018 a 2022 / Factors associated with cesarean section in users treated at a private clinic in Chile, years 2018 to 2022

Introducción: De acuerdo con lo reportado por la Organización para la Cooperación y el Desarrollo Económico, Chile posee una de las tasas más altas de cesárea para el continente, llegando a un 44,7% en 2013 y un 47,7% en 2017, ubicándose en tercer lugar, solo precedido por Turquía y México. Objetivo: Analizar los factores relacionados a intervención de cesárea en las mujeres que atendieron su parto en una clínica privada de la Quinta Región de Chile entre los años 2018 y 2022. Método: Estudio transversal analítico en 9041 usuarias. Se utilizó un modelo de regresión logística con odds ratio y sus intervalos de confianza del 95% para evaluar la asociación con variables sociodemográficas y obstétricas. Resultados: La prevalencia de cesárea fue del 85,1% en el periodo estudiado. La condición de gestante primípara, la cesárea previa, la presencia de patología materna o fetal, la ausencia de trabajo de parto y la esterilización quirúrgica presentaron mayor probabilidad de cesárea, mientras que para la edad gestacional, menor o igual a 36 semanas, ésta fue menor. Conclusiones: Destaca un alta prevalencia de cesáreas para el periodo de estudio, superior a lo reportado en la literatura.

Introduction: According to the Organisation for Economic Co-operation and Development, Chile has one of the highest caesarean section rates on the continent, reaching 44.7% in 20132 and 47.7% in 20173 , ranking third only to Turkey and Mexico. Objective: Analyze the factors related to cesarean section intervention in women who delivered in a private clinic in the Fifth Region of Chile, from 2018 to 2022. Method: Cross-sectional study involving 9,041 users. A logistic regression model with odds ratio and its 95% confidence intervals was used to assess associations with sociodemographic and obstetric factors. Results: The prevalence of cesarean section during the study period was 85.1%. Primiparous status, previous cesarean section, presence of maternal and fetal pathology, absence of labor and surgical sterilization were associated with an increased likelihood of cesarean section, while gestational age 36 and under weeks showed a decreased chance. Conclusions: A high prevalence of cesarean sections stands out for the study period, higher than that reported in the literature.

OSTEOMA GIGANTE EM RAMO ASCENDENTE DE MANDÍBULA ­ ASPECTOS RADIOGRÁFICOS E TOMOGRÁFICOS DE UM CASO / GIANT OSTEOMA IN THE ASCENDING RAMUS OF THE MANDIBLE ­ RADIOGRAPHIC AND TOMOGRAPHIC ASPECTS OF A CASE

O osteoma é um tumor benigno incomum de origem óssea, caracterizado por proliferação de osso compacto ou medular. É mais comum em adultos entre trinta e cinquenta anos, sem predileção por gênero e pode ser categorizado como central, periférico ou extra-esquelético. Este estudo tem por objetivo relatar o caso de uma paciente que foi atendida na Odontoclínica Central da Marinha com diagnóstico final de Osteoma com cerca de 10 anos de evolução. Paciente mulher, 58 anos, melanoderma, encaminhada por queixa de dor à mastigação do lado esquerdo e desvio de mandíbula para o lado direito. Ao exame físico, observou-se assimetria facial com aumento de volume bem delimitado de consistência firme em região parotídea do lado esquerdo, além de abaulamento em palato. Radiograficamente, observou-se imagem radiopaca de formato arredondado e bem definida, acometendo ramo ascendente da mandíbula, estendendo-se para côndilo e processo coronoide do lado esquerdo. Na tomografia computadorizada de feixe cônico, notou-se imagem hiperdensa, multilobular, bem definida e corticalizada, localizada do lado esquerdo da mandíbula, envolvendo o ramo ascendente, rompendo a cortical lingual e invadindo a região craniana dos tecidos moles. A paciente foi submetida à biópsia incisional com laudo histopatológico compatível com osteoma. Osteomas gigantes são incomuns, principalmente, em região de maxilares. O cirurgião-dentista deve estar atento a essa patologia devido ao risco de envolvimento com síndromes, também por afetar estética e função dos pacientes afetados.

Osteoma is an unusual benign tumor of bone origin characterized by proliferation of compact or medullary bone. It is most common in adults between the third and fifth decades of life, with no gender predilection and can be categorized as central, peripheral or extra-skeletal. This study aims to report the case of a patient who was seen at the Odontoclínica Central da Marinha with a final diagnosis of Osteoma with approximately 10 years of evolution. A 58-year-old black woman was referred complaining of pain when chewing on the left side and displacement of the jaw to the right side. On physical examination, facial asymmetry was observed with a well-defined swelling of firm consistency in the parotid region on the left side, in addition to a swollen palate. Radiographically, a rounded and well-defined radiopaque image was observed, affecting the ascending ramus of the mandible, extending to the condyle and coronoid process on the left side. On cone beam computed tomography, a hyperdense, multilobular, well-defined and corticalized image was noted, located on the left side of the mandible, involving the ascending ramus, breaking the lingual cortex and invading the cranial region of soft tissues. The patient underwent an incisional biopsy with a histopathological report compatible with osteoma. Giant osteomas are unusual, mainly in the jaw region. The dentist must be aware of this pathology due to the risk of involvement with syndromes, also because it affects the aesthetics and function of affected patients.

ORAL MELANOMA: WHAT DOES THE DENTIST NEED TO KNOW? / MELANOMA ORAL: O QUE O DENTISTA PRECISA SABER?

O melanoma oral é uma neoplasia maligna de melanócitos, caracterizada por um comportamento agressivo e prognóstico extremamente reservado. Melanomas na cavidade oral são raros e geralmente são diagnosticados em estágio avançado, reduzindo a sobrevida dos pacientes. O objetivo desta revisão narrativa de literatura é compilar os aspectos essenciais do melanoma oral e demais pigmentações para orientar o diagnóstico precoce pelo cirurgião-dentista. Realizou-se uma pesquisa nas bases de dados Pubmed, Embase, Lilacs e Cochrane. O melanoma oral apresenta-se como uma mácula ou nódulo, de coloração castanha ou preta, podendo demonstrar variações na cor e até mesmo despigmentações. Ele tem predileção pelo palato e pela gengiva maxilar, usualmente é assintomático, e aparenta acometer ligeiramente mais o sexo masculino, especialmente entre a 4ª e 7ª décadas de vida. Apesar de possuir características clínicas similares com o melanoma cutâneo, são consideradas variantes distintas. O cirurgião-dentista deve conhecer as principais características clínicas do melanoma oral e demais pigmentações da cavidade oral a fim de realizar o diagnóstico precoce da neoplasia e conduzir o caso adequadamente.

Oral melanoma is a malignant neoplasm of melanocytes, characterized by aggressive behavior and an extremely poor prognosis. Melanomas in the oral cavity are rare and are usually diagnosed at an advanced stage, reducing patient survival. The aim of this narrative literature review is to compile the essential aspects of oral melanoma and other pigmentations to guide early diagnosis by the dentist. Comprehensive searches were conducted in the PubMed, Embase, Lilacs, and Cochrane databases. Oral melanoma typically presents as a macule or nodule, brown or black in color, and may show variations in color and even depigmentation. It has a predilection for the palate and maxillary gingiva, is usually asymptomatic, and affects slightly more males, especially between the 4th and 7th decades of life. Although they share similar clinical characteristics with cutaneous melanoma, they are considered distinct variants. Dentists must be aware of the main clinical characteristics of oral melanoma and other pigmentations of the oral cavity to make an early diagnosis of the neoplasm and manage the case appropriately.

Implante Inmediato en Zona Estética Anterior con Pérdida Parcial de la Cortical Vestibular: Reporte De Caso y Revisión de Literatura

El tratamiento con implantes dentales hoy en día es un procedimiento clínico de rutina que permite rehabilitar a los pacientes con prótesis fijas. En este caso presentamos un tratamiento complejo de implantación inmediata del sector anterior con pérdida parcial de la cortical vestibular en el que se realizó una regeneración ósea guiada y provisionalización en un tiempo quirúrgico en un paciente con patología renal. Complementamos el estudio con una revisión de la efectividad de las técnicas utilizadas y las posibles respuestas celular asociadas a la patología renal.

Treatment with dental implants nowadays is a routine clinical procedure that allows patient rehabilitation with fixed prostheses. In this case we present a complex treatment of immediate implantation of the anterior sector with partial loss of the vestibular cortex, in which guided bone regeneration and provisionalization was performed in surgical time in a patient with kidney pathology. The study was complemented with a review of the effectiveness of the techniques used and the possible cellular responses associated with kidney pathology.

Carcinoma sarcomatoide hepático primario metastásico, una neoplasia infrecuente / Primary hepatic sarcomatoid carcinoma, an unusual case

Resumen El carcinoma sarcomatoide primario hepático es un tumor agresivo que representa el 0.4-0.7% de todas las neoplasias primarias hepáticas. Se asocia a hepa topatía por virus hepatotropos, es más prevalente en la población asiática y en su histología se evidencian componentes de carcinoma y sarcoma. No posee carac terísticas clínicas ni imagenológicas patognomónicas y su diagnóstico se realiza en base a los hallazgos de la anatomía patológica e inmunohistoquímica. La cirugía en estadio localizado representa la única modalidad terapéutica con impacto en la sobrevida. Reportamos el caso de una paciente de 72 años, coreana, con an tecedentes de hepatopatía crónica por virus B, a quien se le diagnosticó un carcinoma sarcomatoide hepático primario con metástasis ósea y ganglionares.

Abstract Primary hepatic sarcomatoid carcinoma is a very ag gressive tumor, representing 0.4-0.7% of all primary he patic neoplasms. The disease is associated with liver dis ease due to hepatotropic viruses and is more prevalent in Asians. Histology shows sarcomatous and carcinoma components. It does not have pathognomonic clinical or imaging characteristics and its diagnosis is based on the pathological and immunohistochemistry findings. Surgery could prolong survival in localized stages. We report the case of a 72-year-old Korean patient with a history of chronic liver disease due to B virus, who was diagnosed with primary hepatic sarcomatoid carcinoma with bone and lymph node metastases.

Epidemiología de padecimientos frecuentes en cirugía maxilofacial: Hospital General Regional No. 1, Tijuana / Epidemiology of frequent conditions in maxillofacial surgery: Hospital General Regional No. 1, Tijuana

Introducción: uno de los servicios que el IMSS ofrece a sus derechohabientes es la cirugía maxilofacial; sin embargo, existen pocos estudios en esta área, que nos puedan proporcionar información acerca de la epidemiología de los tratamientos realizados. Objetivo: conocer la epidemiología de las intervenciones quirúrgicas en Cirugía Maxilofacial remitidas de diferentes Unidades de Medicina Familiar (UMF) al Hospital General Regional No.1 (HGR No.1) del turno vespertino en Tijuana, Baja California, México. Material y métodos: estudio descriptivo retrospectivo basado en revisión de «expedientes clínicos electrónicos¼. Se revisaron 2,945 expedientes, de los que se obtuvieron datos generales, UMF y diagnóstico, registrados bajo la plataforma Expediente Clínico Electrónico y Sistema de Información de Medicina Familiar. Se confeccionó un documento con los expedientes analizados. Fueron excluidos pacientes que no cumplieron con un diagnóstico definido por el cirujano maxilofacial o presentaron inasistencia. Debido a la pandemia por SARS-CoV-2 se excluyeron algunos meses. La muestra final la integraron 2,452 pacientes. Resultados: el 2019 fue el año con el mayor número de registros. Predomina el género femenino. La mediana de edad en el estado es 30 años, relacionando el diagnóstico más común «dientes incluidos¼ coincide con la edad predominante entre 20 y 44 años. La UMF 27 remitió más pacientes a hospital. Conclusión: estomatología y médicos familiares pueden hacer envíos a hospitales. El HGR No.1 no cuenta con el instrumental adecuado, el servicio se satura constantemente, es demasiada la demanda, continuamos con poco instrumental y falta de personal (AU)

Introduction: one of the services that the IMSS offers to its beneficiaries it is maxillofacial surgery; however, there are few studies in this area that can provide us with information about the epidemiology of the treatments carried out. Objective: to know the epidemiology of surgical interventions in Maxillofacial Surgery referred from different Family Medicine Units (UMF) to the Hospital General Regional No.1 (HGR No.1) of the evening shift in Tijuana, Baja California, México. Material and methods: retrospective descriptive study based on the review of «Electronic Clinical Files¼. 2,945 records were reviewed, obtaining general data, UMF and diagnosis, registered under the platform Electronic Clinical Record (ECE) and Family Medicine Information System (SIMF). Prepared a document with the files analyzed. Patients who did not meet a diagnosis defined by the Maxillofacial Surgeon or who were absent were excluded. Due to the SARS-CoV-2 pandemic, some months were excluded. The final sample was 2,452 patients. Results: 2019 was the year with the highest number of records. The female gender predominates. The median age in the state is 30 years, relating the most common diagnosis «included teeth¼ coincides with the predominant age between 20 and 44 years. UMF 27 referred more patients to hospital. Conclusion: stomatology and family doctors can make referrals to hospitals. HGR No.1 does not have adequate instruments, the service is constantly saturated, the demand is too high, we continue with few instruments and lack of personnel (AU)

Biópsia excisional de lipoma em fundo de vestíbulo mandibular: um relato de caso / Excisional biopsy of lipoma in the buccal mandibular vestibule: a case report

Introdução: os lipomas são as neoplasias benignas de origem mesenquimal mais comum, podendo acometer diversas partes do corpo, sendo a região maxilofacial, de fato, uma das menos frequentes. Clinicamente, manifestam-se como aumentos de volume de crescimento lento e circunscrito, de base séssil ou pediculada, superfície lisa e consistência macia e coloração amarelada. Os sítios intra-orais mais acometidos são a mucosa jugal e o vestíbulo bucal.Dentre suas variantes microscópicas mais comuns, estão o fibrolipoma, composto de um componente fibroso. No entanto, tais variações não afetam o prognóstico do seu tratamento, que deve ser realizado através da excisão conservadora da lesão. OBJETIVO: O presente trabalho tem como objetivo relatar um caso atípico de lipoma intra-oral. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 67 anos, apresentou-se com aumento de volume em região de fundo de vestíbulo mandibular com evolução de, aproximadamente, 10 meses, indolor, com queixas de dificuldade no posicionamento da prótese dentária inferior. O diagnóstico inicial foi de lipoma, confirmado por análise anatomopatológica através de biópsia excisional da peça. Considerações finais: O tratamento de lipomas intra-orais preconizado pela literatura é a excisão local, obtida por meio da biópsia excisional, sendo uma solução eficaz e de baixa morbidade ao paciente(AU)

Introduction: lipomas are the most common benign neoplasms of mesenchymal origin, which can affect different parts of the body, with the maxillofacial region, in fact, one of the least frequent. Clinically, they manifest as slow-growing, circumscribed swellings, with a sessile or pedunculated base, smooth surface, soft consistency and yellowish color. The most affected intraoral sites are the buccal mucosa and the buccal vestibule. Among its most common microscopic variants are the fibrolipoma, composed of a fibrous component. However, such variations do not affect the prognosis of its treatment, which must be carried out through conservative excision of the lesion. OBJECTIVE: This study aims to report an atypical case of intraoral lipoma. CASE DESCRIPTION: A 67-yearold female patient presented with swelling in the bottom region of the mandibular vestibule with an evolution of approximately 10 months, painless, with complaints of difficulty in positioning the lower dental prosthesis. The initial diagnosis was lipoma, confirmed by anatomopathological analysis through excisional biopsy of the specimen. Final considerations: The treatment of intraoral lipomas recommended by the literature is local excision, obtained through excisional biopsy, being an effective solution with low morbidity for the patient(AU)

Seis meses de entrenamiento en Colangiografía Endoscópica Retrograda en centro formador de alto volumen ¿es suficiente? Experiencia inicial en un hospital de la Araucanía

Introducción: La colangiopancreatografía endoscópica retrógrada (CPRE) es un procedimiento terapéutico para diversas patologías biliopancreáticas. Existen diversos centros de formación con una variedad de tiempos de práctica para la realización de CPRE. Objetivo: Evaluar resultados iniciales post entrenamiento en endoscopia terapéutica en el Instituto Chileno-Japonés del Hospital San Borja Arriarán, analizando 150 CPRE consecutivas, describiendo aspectos técnicos, morbilidad y mortalidad, realizadas entre noviembre de 2017 a enero de 2019 por un único operador en un hospital de la Araucanía. Método: Análisis retrospectivo del registro prospectivo de los 150 primeros casos consecutivos de CPRE realizados en el hospital San José de Victoria (HSJV). Se midieron variables clínicas, técnicas y de laboratorio. Se utilizó estadística descriptiva con medidas de tendencia central, dispersión y tendencia extrema. Resultados: Serie de 150 pacientes sometidos a CPRE: Edad promedio 60,1 años, mediana de 65 y edades extremas 16-98 años. Sexo femenino 69,3%. Indicaciones CPRE: 67,3% coledocolitiasis sin colangitis, 16,7% colangitis aguda, 6% estenosis de vía biliar benigna, 3.3% tumor periampular. Todos apoyados por anestesista, 50,7% propofol y 49.3% anestesia general. Tasa de canulación biliar 96,7%. Precorte 19,3%. Complicaciones reportadas alcanzaron el 4,67%, sin mortalidad por el procedimiento en la serie. Conclusiones: Los resultados de esta serie muestran que la formación obtenida por el profesional logró los estándares sugeridos para un procedimiento efectivo y seguro, destacando una tasa de canulación del 96,7%, siendo superior a lo que las guías internacionales describen como exitosa. La morbilidad asociada a CPER es comparable a cifras nacionales e internacionales.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for various biliopancreatic pathologies. There are different training centers with a variety of practice times for performing ERCP. Objective: This study aims to evaluate the initial post-training results in therapeutic endoscopy at the Chilean-Japanese Institute of San Borja Arriarán Hospital, analyzing 150 consecutive ERCP procedures performed between November 2017 and January 2019 by a single operator at a hospital in La Araucanía, describing technical aspects, morbidity, and mortality. Method: Retrospective analysis of the prospective registry of the first 150 consecutive ERCP cases performed at the San José de Victoria Hospital (HSJV). Clinical, technical and laboratory variables were measured. Descriptive statistics were produced with measures of central tendency, dispersion and extreme tendency. Results: Series of 150 patients undergoing ERCP: mean age 60.1 years, median 65 and extreme ages 16-98 years. Female sex 69.3%. ERCP indications: 67.3% choledocholithiasis without cholangitis, 16.7% acute cholangitis, 6% benign bile duct stenosis, 3.3% periampullary tumor. All supported by an anesthetist, 50.7% propofol and 49.3% general anesthesia. Biliary cannulation rate 96.7%. Precut 19.3%. Reported complications reached 4.67%, with no mortality from the procedure in the series. Conclusions: The results of this series show that the training obtained by the professional improves the standards proposed for an effective and safe procedure, highlighting a cannulation rate of 96.7%, higher than what international guidelines describe as successful. The morbidity associated with ERCP in our series is comparable to national and international figures.

Displasia dentinaria tipo I: Manejo clínico y estudio histológico a propósito de dos casos / Dentin dysplasia type I: clinical management and histological study based on two cases

La displasia dentinaria tipo I (DD-I) corresponde a una alteración dentinaria de heterogeneidad genética y penetrancia completa, en donde se presenta un defecto en el desarrollo de las raíces de los dientes tanto temporales como definitivos. Clínicamente se observan dientes con extrema movilidad junto con antecedentes de exfoliación prematura o espontánea. Los defectos estructurales de los tejidos dentarios, tales como DD-I; implican un desafío ya que son pocos los casos documentados en la literatura que hablan de esta condición. Además implican un tratamiento multidisciplinario y altamente invasivo. El objetivo de este artículo es presentar dos casos de DD-I, enfatizando en su tratamiento y características histopatológicas.

Dentin Dysplasia Type I (DD-I) consists of a pathological dentinary alteration with genetic heterogeneity that results in a defectuous development of dental roots both in primary and secondary dentition. Clinically we can appreciate teeth with extreme pathological mobility and premature or spontaneous exfoliation. Alterations within normal dental structure, such as DD-I imply a challenge for the common practitioner, because of the scarce number of case reports with in the scientific literature regarding this condition and also, because of the need for a highly invasive and multidisciplinary approach they require. The aim of this article is to present two DD-I cases, emphasizing on their treatment and histopathological features.

Presacral tumor, experience of two cases in Mexico and review of the literature

Presacral or retrorectal tumors are rare, they can present different histologic strains and they can also be benign or malignant. These tumors represent a challenge for the surgeon due to their location in the presacral space and due to the low incidence and written information. Various surgical approaches have been described. We present the case of two patients who were diagnosed with presacral tumors (hamartoma and schwannoma) and who underwent a posterior approach for the removal of the tumors. There are several approaches for the treatment of presacral tumors, but in our experience, the posterior approach has shown adequate results without recurrence in the medium-term follow-up. The purpose of the manuscript is to document our experience in the management of two patients.

A micro bacteriological culture assessment of the histopathological alterations in liver and bile in gallstone disease

Background: The present investigation aims to evaluate both the intensity and occurrence of hepatic impairment in patients afflicted with gallstone disease, examining the involvement of bacteria in the progression of these alterations. Methods: This prospective observational investigation was carried out on 189 patients scheduled for open or laparoscopic cholecystectomy at IGIMS in Patna, Bihar, India. In all the patients, laboratory and radiological investigations were performed. A healthy section of the liver border near the gallbladder fossa was chosen and grasped with non-traumatic forceps. Approximately 1 cm of the liver edge was excised using scissors and forwarded for histopathological analysis. Results: An examination of 189 liver biopsy specimens revealed that 87 (46%) patients showed no abnormalities, while 102 patients (54%) exhibited one or more changes. Upon analysing the liver biopsy samples from the control cohort (41 patients) during autopsy, 37% of the cases were identified to display hepatic lipidosis, while 48% of the cases showed lymphocytic invasion. Importantly, no cases of acute inflammatory changes were detected in the control cohort. Microbiological analysis was conducted on 96 patients, of which 33 (34%) showed positive cultures, with one or more microorganisms isolated from either the biliary tract or liver. Among these, 74% (24 cases) originated from the bile or gallbladder, while 26% (9 cases) were isolated from the liver. Conclusions: Gallstone disease induces significant liver histological changes, notably more prevalent in patients with prolonged symptoms. The present study clearly identifies this and underscores the importance of timely diagnosis and intervention for the effective management of this disease.

Congruencia Diagnóstica Clínica-Histopatológica de Lesiones en Cavidad Oral, en la Faculta de Odontología, Universidad de Costa Rica, en el Período 2016-2019

El conocimiento de la patología oral, y su correcto diagnóstico es fundamental en Odontología, puesto que un diagnóstico tardío, particularmente en casos de lesiones premalignas o malignas, pueden conducir a serias consecuencias para el paciente. El objetivo de este trabajo fue establecer la congruencia diagnóstica clínica - histopatológica de lesiones en cavidad oral en pacientes que asistieron a la Facultad de Odontología, Universidad de Costa Rica, y a quienes se les realizó biopsia de la lesión, durante el período 2016-2019. El estudio fue descriptivo y retrospectivo, basado en datos de reportes histopatológicos en la población mencionada, por presentar alguna lesión, de tejidos blandos o duros, en cavidad oral. La muestra estadística fue por conveniencia, no probabilística y no aleatoria. Las técnicas estadísticas utilizadas fueron descriptivas para el análisis de la información, el cual se basó en la distribución de frecuencias y cruce de variables. El procesamiento estadístico de los datos se diseñó en una base de datos creada en Excel. La muestra comprendió 160 reportes histopatológicos de los cuales se excluyeron 14. La edad promedio de los pacientes fue 42 años (rango 2 - 78 años). La proporción hombre: mujer correspondió 1:1.4, predominado el sexo femenino en 58,9 %. La congruencia del diagnóstico histopatológico con el diagnóstico clínico correspondió a 55,8 %. La congruencia de los diagnósticos demuestra el conocimiento del profesional en identificar la lesión clínicamente de forma correcta, lo que permite actuar en el momento preciso y confirmar la impresión clínica diagnóstica de una patología mediante el estudio histopatológico, el cual es el estándar oro. El problema radica en aquellos casos en que hay discrepancia diagnóstica, pues exige conocer los factores responsables de esta discrepancia, exige la búsqueda de soluciones y exige reforzar y redireccionar la formación académica del profesional y de los estudiantes para reconocer y describir estas lesiones.

Knowledge of oral pathology and its correct diagnosis is fundamental in Dentistry, since a late diagnosis, particularly in cases of premalignant or malignant lesions, can lead to serious consequences for the patient. The objective of this study was to establish the clinical- histopathological diagnostic consistency of lesions in the oral cavity in patients who attended the Faculty of Dentistry, Universidad de Costa Rica, and who underwent a biopsy of the lesion, during the period 2016-2019. The study was descriptive and retrospective, based on data from histopathological reports in the mentioned population, due to presenting some lesion, soft or hard tissue, in the oral cavity. The statistical sample was for convenience, non- probabilistic nor random. The statistical techniques used were descriptive for the analysis of the information, which was based on frequency distribution and crossing of variables. The statistical processing of the data was designed in a database created in Excel. The sample collects 160 histopathological reports, of which 14 were excluded. The average age of the patients was 42 years (range between 2 - 78 years old).The male:female ratio corresponded to 1:1.4, with a predominance of the female sex at 58.9 %.The congruence of the histopathological diagnosis with the clinical diagnosis corresponded to 55.8 %. Diagnostic consistency demonstrates knowledge of the professional in correctly identifying the lesion clinically, which allows acting at the precise moment and confirming the diagnostic clinical impression of the pathology via histopathological study which is the gold standard. The problem lies in those cases in which there is a diagnostic discrepancy, since it requires having knowledge of the underlying factors and therefore, requires searching for solutions, reinforcing and redirecting the academic training of professionals and students to recognize and describe these lesions.