Occurrence of nonarticular incidental findings on panoramic radiographs in painful temporomandibular disorders / Ocurrencia de hallazgos incidentales no articulares en ortopantomografias en los trastornos temporomandibulares dolorosos

Facial pain is one of the symptoms of temporomandibular disorders (TMDs) but can be associated with other pathological conditions. The present study retrospectively evaluated the occurrence of nonarticular incidental findings in panoramic radiographs in a group of patients with painful TMDs. Outpatients with a diagnosis of TMD were included and distributed into three groups: arthralgia, myalgia or arthralgia and myalgia, according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Nonarticular incidental findings of their panoramic radiographs were classified in relation to pathological, dental and endodontic status. The dependency relationships among the variables were analyzed using the likelihood test. Sixty patients (38 women and 22 men; mean age: 36.9 years) were evaluated. There was a predominance of arthralgia plus disc displacement (43.4 %), followed by myopain plus arthralgia and disc displacement (38.3 %) and myopain (18.3 %). Pathologic radiographic changes such as bone loss, caries, maxillary sinus opacification and periapical lesions were frequent. Dental alterations such as the absence and altered position of teeth and impacted teeth were frequent. Endodontic changes such as periapical lesions with or without endodontic treatment were frequent. There was no significant difference between groups except for gyroversion. The incidental findings were compatible with caries, sinusitis, impacted tooth and periapical lesion, which may be associated with orofacial pain and could potentially be superimposed on the initial diagnosis, although this hypothesis was discarded. Findings such as the absence and altered position of teeth were also frequent, which may represent occlusal factors associated with TMDs.

El dolor orofacial es uno de los síntomas de los trastornos temporomandibulares (TTM), pero puede estar asociado con otras afecciones patológicas. El presente estudio evaluó retrospectivamente la aparición de hallazgos incidentales no articulares a través de ortopantomografías en un grupo de pacientes con TTM dolorosas. Se incluyeron pacientes con diagnóstico de TTM y se distribuyeron en tres grupos: artralgia, mialgia o artralgia y mialgia, de acuerdo con los criterios de diagnóstico para los trastornos temporomandibulares (DC/TMD). Los hallazgos incidentales no articulares de las ortopantomografias se clasificaron en relación al estado patológico, dental y endodóncico. Las relaciones de dependencia entre las variables se analizaron mediante la prueba de probabilidad. Fueron evaluados 60 pacientes (38 mujeres y 22 hombres; edad media: 36,9 años). Hubo predominio de artralgia más desplazamiento de disco (43,4 %), seguido de mialgia más artralgia y desplazamiento de disco (38,3 %) y mialgia (18,3 %). Las alteraciones radiográficas patológicas como pérdida ósea, carie dentaria, opacificación del seno maxilar y lesiones periapicales fueron frecuentes. Entre las alteraciones dentales, las impactaciones, malposiciones o ausencias dentarias fueron frecuentes. Entre las alteraciones endodóncicas, las lesiones periapicales frecuentes. No hubo diferencias significativas entre los grupos, excepto para la girosversión dentaria. Los hallazgos incidentales fueron compatibles con carie dentaria, sinusitis, diente impactado y lesión periapical, lo que podría estar asociado con el dolor orofacial y así estar sobrepuesto en el diagnóstico inicial, aunque esta hipótesis fue descartada. Hallazgos como la ausencia y la posición alterada de los dientes también fueron frecuentes, lo que puede representar factores oclusales asociados con TTM.

Non-familial Cherubism – Report of a case / Querubim não familiar - Relatório de caso

The Cherubism is a rare disease that affects the middle and lower third of the facein individuals at the time of childhood. It is a rarehereditary benign bone disease with an autosomal dominant inheritance. The familial distribution may affect different generations and isolated nonfamilial cases have also been reported in literature. Lesions appear as cystic multilocular radiolucencies, histologically, they resemble central giant cell granluloma and hyperpara thyroidism brown tumorwith numerous randomly distributed multinuclea tedgiant cells and vascular spaces within a fibrous connective tissue stroma. Objective: The aim of this study is to report the importance of the diagnosis of this pathology and the variety of treatments availablein the literature, thus guiding to an individualized treatment. Case Report: Caucasian 8 years-oldfemale, in good general condition, was referred to Service of Oral and Maxillofacial Surgery of Erasto Gaertner Hospital (EGH), Curitiba – PR, Brazil, complaining of bilateral swelling of the maxilla and mandible since 4 years-old. Apparently, the girl isthe first one who developed the genetic pathologyin at least 4 generations of her family. After biopsy, cherubism diagnosis was confirmed and the treatment of choice was periodic monitoring. Discussion: Cherubism studies with long-term follow-up with clinical and radiographic documentation indicate that the spontaneous resolution of bone lesions israre. Treatment of cherubism is controversial and various modalities have been reported as the use of calcitonin, osseous plasty surgery, curettage, orthognathic surgery, liposuction and palliative treatments. Conclusion: cherubism is a rarecondition that affects individuals in childhood that lead to some facial alterations, those patients need an special care and an well trained team to treat these disease more carefully and wisely noting that exist a series of option of new treatments in this cases...

Introdução: O Querubismo é uma doença rara que afeta o terço médio e inferior da face em indivíduos no momento da infância. É uma doença óssea hereditária benigna com herança autossômica dominante sendo que a distribuição familial pode afetar diferentes gerações, todavia casos não-familiares isolados também foram relatados na literatura. As lesões apresentam se radiograficamente como cistos multiloculados radiolúcidos e histologicamente se assemelham ao granuloma central de células gigantes e ao tumor marrom do hiper paratireoidismo com numerosas células gigantes multinucleadas distribuídos aleatoriamente e espaços vasculares dentro de um estroma de tecido conjuntivo fibroso. Objetivos: O objetivo deste estudo é relatar a importância do diagnóstico desta patologia e da variedade de tratamentos disponíveis na literatura, orientando dessa maneira a um tratamento individualizado. Relato de Caso: Mulher, caucasiana, 8 anos de idade, em bom estado geral. Foi encaminhada ao Serviço de Cirurgia Bucomaxilofacial do Hospital Erasto Gaertner (EGH), Curitiba - PR, Brasil, com queixa de inchaço bilateral da maxila e da mandíbula desde os 4 anos de idade. Em avaliação notou-se que menina é a primeira pessoa que desenvolveu a patologia empelo menos quatro gerações de sua família. Após biópsia o diagnóstico de cherubism foi confirmado e o tratamento de escolha foi a monitorização periódica. Discussão: estudos de cherubism a longo prazo de follow-up com documentação clínica e radiográficas indicam que a resolução espontânea das lesões ósseas são raras. O tratamento do cherubism é controverso e diversas modalidades têm sido relatados como o uso de calcitonina, a cirurgia de plastia óssea, curetagem cirurgia ortognática, lipoaspiração e tratamentos paliativos...

Presentación mandibular primaria de linfoma no Hodgkin / Primary non-Hodgkin´s lymphoma of the jaw

Se informa sobre el caso de una paciente de 80 años que presentó un linfoma no Hodgkin con compromiso de la mandíbula, con una tumoración de rápido crecimiento en el lado derecho de la cara, de 20 días de evolución. Se llegó al diagnóstico final de linfoma difuso de células grandes de fenotipo B (LDCGB), y la paciente fue derivada a un centro oncológico regional, donde pudo alcanzar una resolución casi completa del tumor

Florid osseous dysplasia: report of two cases and a review of the literature / Displasia ósea florida: reporte de dos casos y revisión de la literatura

Florid osseous dysplasia (FOD) is a benign condition of the jaws in which the normal architecture of bone is replaced by a fibrous tissue containing a variable amount of bone and cementum-like tissue. This lesion is most commonly seen in middle aged black women. FOD appears as dense, lobulated masses, often symmetrically located in the mandible, rarely in the maxilla. The lesion is usually asymptomatic and benign. However, a secondary infection may occur and its treatment can be difficult and complicated. This paper reports the case of two patients. The first one is a white woman aged 65 and the second one is a black woman aged 70, both diagnosed with FOD, revealed by secondary infections. The diagnosis was based on clinical and radiographic findings, as biopsy is contraindicated. Radiological and clinical features of FOD and its management will be also discussed on the basis of recent literature.

La displasia ósea florida (DOF) es una patología benigna del maxilar y mandíbula en la que se sustituye la arquitectura normal del hueso por un tejido fibroso que contiene una cantidad variable de tejido óseo y cementoide. Esta lesión es más frecuente en mujeres negras de edad media. La DOF aparece como una masa densa, lobulada, a menudo situada simétricamente en la mandíbula, rara vez en el maxilar. La lesión suele ser asintomática y benigna. Sin embargo, una infección secundaria puede ocurrir y su tratamiento puede ser difícil y complicarse. Este artículo reporta el caso de dos pacientes. La primera es una mujer blanca de 65 años y la segunda es una mujer negra de 70 años, ambas diagnosticadas con DOF, revelada por infecciones secundarias. El diagnóstico se basó en los hallazgos clínicos y radiológicos, ya que la biopsia está contraindicada. Las características clínicas y radiológicas de la DOF y su manejo son discutidos en base a la literatura reciente.

Van der woude syndrome with an unusual intraoral finding.

Orofacial manifestations of Van der Woude syndrome (VWS) include cleft lip or palate, lower lip pits, hypodontia, hypernasal voice, cleft or bifid uvula, syngnathia, narrow high arched palate, and ankyloglossia. Extraoral manifestations include limb anomalies, popliteal webs, accessory nipples, congenital heart defects, and Hirschsprung disease. We report an interesting case of VWS with characteristic orofacial features along with an unusual additional finding of fusion of primary mandibular left lateral incisor and canine in a 7-year-old boy.

Multiple dental anomalies and aggressive periodontitis: A coincidence or an association.

Aggressive periodontitis (AgP) comprises a group of rare, often severe, rapidly progressive forms of periodontitis mostly characterized by an early age of clinical manifestation and a distinctive tendency for cases to aggregate in families. Abnormal dental morphology and position have been associated with severe periodontal diseases. The purpose of this paper is to report a case of multiple dental anomalies associated with AgP. This paper reports a case of unusual association of multiple dental anomalies to AgP. Clinical findings and history led to the diagnosis of localized AgP, and radiologically. It was associated with multiple dental anomalies, especially supernumerary roots. Thus, the present case represents a very interesting demonstration of AgP association with supernumerary roots and the nature of this association merits further investigations.

Caracterización de pacientes tratados por Cirugía Maxilofacialen la Clínica CES 2005-2007 / Characterization of patients treated at CES Clinic by the maxillofacial service

Introducción y Objetivo: La cirugía maxilofacial se ocupa de la prevención, estudio, diagnóstico, tratamiento quirúrgico y medicamentoso de las patologías que afectan la cavidad bucal y la cara, así como las estructuras cervicales relacionadas. El presente trabajo se orienta a evaluar las principales causas por las que se realiza cirugía maxilofacial, los diferentes tipos de patologías, la edad, el género, los días de estancia y las complicaciones que se presentaron en los pacientes de cirugía maxilofacial de la clínica CES. Materiales y Métodos: Se realizó un estudio descriptivo, transversal, retrospectivo basado en la información tomada de historias clínicas de 648 pacientes intervenidos por cirugía maxilofacial en la clínica CES entre los años 2005 a 2007. Resultados: El tipo de atención que más se presentó fue particular 52.6%, el tipo de cirugía más frecuente fue electiva 90%, las causas más comunes de los traumas fueron accidentes de tránsito y lesiones por caídas, la localización más frecuente de las fracturas fue el tercio inferior y la zona más afectada fue el ángulo mandibular, el procedimiento quirúrgico que predominó fue la cirugía ortognática 55%, requirieron fijación intermaxilar el 30.7%. El 50% de los pacientes fueron hospitalizados y el 0.92% presentó alguna complicación. Conclusiones: La mayoría de las cirugías realizadas fueron electivas, particulares y ortognáticas, predominando la población adulta joven de sexo femenino, la causa principal de los traumas fueron accidentes de tránsito y lesiones por caídas, la mitad de los pacientes requirió hospitalización y el promedio fue un día.

Introduction and Objective: Maxillofacial surgery deals with the prevention, study, diagnosis and surgical treatment of disorders affecting the oral cavity and face, neck and related structures. The purpose was to assess the main causes for the performance of that surgery, different types of diseases, age, gender, days of hospitalization, and complications that were presented at the CES clinic in the area of maxillofacial surgery. Materials and Methods: A descriptive, cross-sectional, retrospective study was performed. The information for analysis was taken from medical records of 648 patients operated by maxillofacial surgery at the CES clinic between 2005 and 2007. Results: The type of treatment most prevalent was private 52.6%, the most common surgery was elective 90%, the most common causes of trauma were from traffic accidents and injuries from falls; the most common site of fractures were the facial lower third and the most affected area was the mandibular angle, the predominant surgical procedure was orthognathic surgery 55%, requiring intermaxillar fixation 30.7%. The 50% of patients were hospitalized and only 0.92% had a complication. Conclusions: The majority of surgeries performed were elective, private and orthognathic, mainly of young female adults, the main cause of trauma were traffic accidents and injuries from falls, half of the patients required hospitalization with one day of average.

Electromyographic activity of masticatory muscles in women with osteoporosis

The purpose of this study was to analyze the electromyographic (EMG) activity and the maximal molar bite force in women diagnosed with osteoporosis in the maxillary and mandibular regions, considering the habits and conditions that lead to development of generalized skeletal bone loss, including on face bones, can disturb the functional harmony of the stomatognathic system. Twenty-seven women with mandibular and maxillary osteoporosis and 27 healthy controls volunteered to participate in the study. A 5-channel electromyographer was used. Muscle activity was evaluated by means of EMG recordings of the masticatory musculature (masseter and temporalis muscles, bilaterally) during the following clinical conditions: rest (5 s); right and left lateral excursions (5 s); protrusion (5 s); maximal dental clenching on Parafilm™ (4 s) and maximal voluntary contraction (4 s). This latter clinical condition was used as the normalization factor of the sample data. It was observed that individuals with osteoporosis presented greater EMG activity when maintaining mandible posture conditions and less activity during dental clenching and when obtaining maximal molar bite force. It may be concluded that facial osteoporosis can interfere on the patterns of masticatory muscle activation and maximal bite force of the stomatognathic system.

Este estudo teve como objetivo analisar a atividade eletromiográfica e a força de mordida molar máxima de indivíduos diagnosticados com osteoporose na região maxilar e mandibular, visto que os hábitos e condições que provocam o desenvolvimento de uma perda óssea generalizada no esqueleto, inclusive no esqueleto facial, podem causar distúrbios na harmonia funcional do sistema mastigatório. Vinte e sete indivíduos portadores de osteoporose na mandíbula e maxila e 27 voluntários sem a doença participaram deste estudo. Um eletromiógrafo de 5 canais foi utilizado. A avaliação da atividade muscular foi realizada por meio de registros eletromiográficos da musculatura mastigatória (músculos masseter e temporal, bilateralmente) durante as seguintes condições clínicas: Repouso (5 s); Lateralidades direita e esquerda (5 s); Protrusão (5 s); Apertamento dental máximo com parafilme (4 s) e a contração voluntária máxima (4 s), sendo que esta condição clínica foi utilizada como fator de normalização dos dados da amostra. Verificou-se que os indivíduos com osteoporose apresentaram maior atividade eletromiográfica durante a manutenção das condições posturais da mandíbula e menor atividade durante o apertamento dental e na obtenção da força de mordida molar máxima. Conclui-se que a osteoporose na região dos ossos da face pode interferir nos padrões de ativação da musculatura mastigatória e na força de mordida máxima do sistema estomatognático.

El sistema masticatorio y las alteraciones funcionales consecuentes a la pérdida dentaria / The masticatory system and functional alterations consequent to tooth loss

A pesar de las mejoras ocurridas en las condiciones de salud general de la población, aún es frecuente, con el proceso de envejecimiento, la de pérdida de piezas dentarias, acarreando disturbios en el sistema masticatorio y reflejándose en todo el organismo del anciano. De esta forma, este trabajo realizó una revisión de literatura al respecto de este sistema, sus funciones, peculiaridades y alteraciones especialmente relacionadas a la pérdida dentaria, enfatizando la importancia de las rehabilitaciones protésicas para restaurar la función y los cuidados necesarios en el planeamiento, instalación y manutención de las prótesis en los pacientes de la tercera edad. Fue posible concluir que, debido a la complejidad del sistema masticatorio y de todas las estructuras relacionadas, la reunión del mayor número posible de informaciones durante la anamnesis, examen clínico, radiográfico y de modelos de estudio montados en el articulador son de mucha importancia para el éxito de cualquier tratamiento que envuelve pacientes ancianos. Estos tratamientos, deben someterse a un planeamiento multidisciplinar donde cada especialidad siga una secuencia lógica e integrada de ejecución, para que sean alcanzados los resultados anhelados

Despite of the improvements happened in the general conditions of population health, it's frequent the occurrence of teeth loss with the aging. This phenomenon cause masticatory system disturbance and can be observed in all the elderly organism. By this way, this study realized a literature review about this system, its functions, peculiarities and alterations related to the loss of tooth, emphasizing the importance of prosthetic rehabilitations to restore the functions and the necessary care on treatment planning, installation and prosthesis maintenance in elderly people. In virtue of masticatory system complexity and its related structures, it can be concluded that the reunion of a great data number during the anamnesis, clinical and radiographic examination, and the mounting of diagnostic casts in semi-adjustable articulator are very important for a successful treatment involving elderly people. These treatments may involve a multidisciplinary planning where each involved specialty follow a logic and integrated sequence of execution to reach the desired results

Histochemical and polarization microscopic study of two cases of vegetable/pulse granuloma.

Vegetable granuloma (VG) or pulse granuloma (PG) results from the implantation of food particles of plant or vegetable origin. It is usually seen in the periapical or in the sulcus areas. These lesions have been described as a distinct entity and classified into central and peripheral lesions according to the location. Central lesions are asymptomatic, whereas peripheral lesions present as painless sub-mucosal swellings. Many authors have postulated that food particles in VG or PG get implanted and are rapidly digested, and sometimes partly get altered by host responses. The cellulose part of plant foods being indigestible persists in the form of hyaline material, whereas the starch matter gets digested. This cellulose moiety invokes chronic granulomatous response.

Primary failure of tooth eruption associated with secondarily inflamed dental follicle: inflammatory follicular cyst?

Primary failure of eruption represents a cessation of tooth eruption before emergence not due to a physical barrier or abnormal position and has no systemic cause. This failure of tooth eruption is rare phenomenon and it has not been associated with alterations of dental follicle. This case report describes a permanent right first molar with primary failure of eruption at the inferior border of the mandible presenting microscopic, clinical and radiographic findings compatible with follicular cystic lesion. The follicular tissues of this molar showed microscopic aspects of inflammation. Thus, pericoronal tissues surrounding long-term unerupted teeth with primary failure of eruption has potential to develop into odontogenic cysts. The lesion presented herein probably arose in association with a periodontal pocket mesial to the adjacent second molar, representing an atypical inflammatory follicular cyst. This case shares etiological, radiological and microscopic features with the usual form of the inflammatory follicular cyst associated with infected primary teeth, except for the infection pathways reaching the tooth follicle. The controversies regarding the terminology for this cyst are discussed.

A falha primária de erupção é caracterizada pelo não irrompimento de um dente sem que haja impedimento mecânico ou que o dente esteja em posição anormal ou devido à causas sistêmicas. É um fenômeno raro e não foi associado com alterações do folículo dentário. Este relato descreve um caso de falha primária de erupção de um primeiro molar inferior direito permanente, localizado na base da mandíbula, que apresenta achados clínicos, radiográficos e microscópicos compatíveis com cisto folicular. O folículo pericoronário deste molar apresentou aspectos microscópicos de inflamação. Assim como os tecidos pericoronários dos dentes não irrompidos, a longo prazo, os folículos pericoronários dos dentes com falha primária de irrompimento têm o potencial para desenvolver cistos odontogênicos. Esta lesão provavelmente surgiu em associação com uma bolsa periodontal na mesial do segundo molar adjacente, caracterizando um cisto folicular inflamatório atípico. Este caso apresenta características etiológicas, radiográficas e microscópicas comuns nos cistos foliculares inflamatórios associados a dentes decíduos infectados, com exceção das infecções que alcançam o folículo. São discutidas ainda as controvérsias relativas à terminologia deste cisto.

Radicular cyst associated with endodontically treated deciduous tooth: a case report.

This article presents a case report of radicular cyst associated with an endodontically treated deciduous second molar causing displacement of the permanent successor, with accompanying buccal expansion. Cystic sac was removed surgically along with the involved tooth under general anesthesia. Healing was uneventful. Histopathologically the cystic sac was consistent with the features of radicular cyst. Unusual amorphous, eosinophilic, atubular material incorporated within the cystic epithelium was observed.

Propedêutica clínica e terapêutica de cisto odontogênico botrióide: relato de um caso / Clinical and therapeutic considerations about the botryoid odontogenic cyst: repor of a case

Descreve-se clínica e histologicamente um caso de cisto odontogênico botrióide que apresentou três recidivas. Analisa-se a conduta terapêutica ante a essa lesäo, considerando-se sua maior agressividade

Estudo comparativo das excursöes mandibulares máximas, obtidas com e sem pressäo bidigital, em pacientes com disfunçäo dolorosa da articulaçäo temporomandibular / A comparative study of mandibular border positions, under and without forcible expansion, in temporomandibular joint pain dysfunction patients

Foi realizado estudo comparativo das excursöes mandibulares máximas, obtidas com e sem pressäo bidigital, em pacientes portadores de disfunçäo dolorosa da articulaçäo temporomandibular. Foram avaliadas a abertura máxima, a lateralidade direita e a esquerda e a protrusäo máxima. Para cada movimento, foram obtidas 3 mensuraçöes consecutivas. Näo foi verificada estatisticamente significante entre os valores obtidos com e sem pressäo bidigital para a maioria das excursöes mandibulares. Apenas para a lateralidade esquerda a diferença foi significante (p<0,02), sendo aventadas hipóteses para este fato. Näo foi observada diferença significante entre as 3 mensuraçöes