Osteoradionecrosis in a Patient Submitted to Head and Neck Radiotherapy: A Case Report / Osteoradionecrosis en un Paciente Sometido a Radioterapia de Cabeza y Cuello: Reporte de un Caso

ABSTRACT: Radiotherapy applies ionizing radiation at predetermined doses for a limited period of time in order to destroy tumors. The oral cavity, which has a high rate of cell renewal, is affected by the side effects of radiotherapy including osteoradionecrosis (ORN). This condition occurs due to irradiated bone tissue that becomes devitalized and exposed in the oral cavity. Conservative therapies are recommended for ORN lesions that are not extensive or in an early stage. Surgical intervention is necessary for extensive areas affected by necrosis. This study reports a case of ORN in the left mandibular body which resulted in a pathological fracture. The treatment consisted of segmental mandibulectomy and the use of a reconstruction plate. Also, low-level laser therapy around bone exposure was performed. After surgery, the patient underwent 6 months of follow-up and was satisfied with the outcome. However, the patient died before control of ORN was achieved due to a heart attack.

RESUMEN: La radioterapia aplica radiación ionizante a dosis predeterminadas durante un período de tiempo limitado para destruir tumores. La cavidad oral, que tiene una alta tasa de renovación celular, se ve afectada por los efectos secundarios de la radioterapia, incluida la osteorradionecrosis (ORN). Esta condición se produce debido al tejido óseo irradiado que se desvitaliza y expone en la cavidad oral. Se recomiendan terapias conservadoras para las lesiones de ORN que no son extensas o en una etapa temprana. La intervención quirúrgica es necesaria para áreas extensas afectadas por necrosis. Este estudio reporta un caso de ORN en el cuerpo mandibular izquierdo que resultó en una fractura patológica. El tratamiento consistió en mandibulectomía segmentaria y el uso de una placa de reconstrucción. Además, se realizó una terapia con láser de bajo nivel alrededor de la exposición ósea. Después de la cirugía, el paciente se sometió a 6 meses de seguimiento y quedó satisfecho con el resultado. Sin embargo, el paciente falleció antes de que se lograra el control de ORN debido a un ataque cardíaco.

Conservative Treatment of Chronic Osteomyelitis Associated with Florid Osseous Dysplasia / Tratamiento Conservador de la Osteomielitis Crónica Asociada con Displasia Ósea Florida

ABSTRACT: Florid osseous dysplasia (FOD) is an extensive form of osseous dysplasia where normal trabecular bone is substituted by fibrous connective tissue and amorphous mineralized tissue. Usually, the lesions are mainly asymptomatic and the patients should be followed with clinical and imaging examination, requiring no intervention. Nevertheless, due to the poor vascularization of the lesion and to local trauma, secondary infections and osteomyelitis may occur. Patients may present with pain, mucosal ulceration, lesion exposure in the oral cavity, fistula and swelling. In such cases, the correct diagnosis and management of the lesion is decisive to reestablish patient's health and quality of life. The aim of this article is to present a case of complicating secondary chronic osteomyelitis treated successfully with conservative intervention. A 68-year-old black female patient reported a "swelling of the gums" that was present for eleven years, with episodes of periodic pain and swelling. On physical examination, a papule with suppuration in the alveolar mucosa in the right side of the mandible was observed. Panoramic radiography and CBCT showed a mixed lesion surrounded by sclerotic bone. The patient was diagnosed with chronic osteomyelitis in association with FOD and treated with antibiotic therapy together with surgical curettage. The incidence, etiophatology, differential diagnosis, treatment and prevention of secondary osteomyelitis associated with FOD are discussed in the light of literature. This information might assist the dentists while choosing the best treatment options for similar cases.

RESUMEN: La displasia ósea florida (DOF) es una forma de displasia ósea donde el hueso trabecular normal es sustituido por tejido conectivo fibroso y tejido mineralizado amorfo. En general, las lesiones son de origen asintomático y los pacientes deben ser seguidos con el examen clínico. Sin embargo, debido a la pobre vascularización de la lesión y al trauma local, pueden producirse lesiones secundarias y osteomielitis. Los pacientes pueden presentarse con dolor, ulceración mucosa, lesión de exposición en la cavidad oral, fístula y edema. En estos casos, el correcto diagnóstico y tratamiento de la lesión es decisivo para reestabilizar la salud y la calidad de la vida. El objetivo de este artículo consistió en presentar un caso de complicación secundaria crónica de osteomielitis tratados con tratamiento conservador. El paciente, negro, de 68 años de edad, consulta por "hinchazón de las encías" que se presentó durante once años, con episodios de dolor. En el examen intraoral, se observó una pápula con supuración en la mucosa alveolar en el lado derecho de la mandíbula. La radiografía panorámica y CBCT mostraron una lesión mixta rodeada de hueso esclerótico. El paciente fue diagnosticado con osteomielitis crónica en asociación con DOF y fue tratado con tratamiento antibiótico junto con curetaje quirúrgico. La incidencia, la etiopatología, el diagnóstico diferencial, el tratamiento y la prevención de la osteomielitis secundaria asociada con DOF se discuten a la luz de la literatura. Esta información puede ayudar a los dentistas a elegir las mejores opciones de tratamiento para casos similares.

Submasseteric abscess: A rare head and neck abscess.

The objective of the article is to highlight and make people aware of a rare abscess which is often missed or misdiagnosed. As only a few cases have been reported, the authors feel that reporting such a case would help in proper management of the disease. We are presenting a 6.5-year-old male child with 3 weeks history of right facial swelling in the parotid region, with low-grade fever and trismus. Submasseteric abscess is a rare abscess which is often misdiagnosed as a parotid abscess or parotitis. Only a few cases have been reported. The cause is mostly dental in origin. Intravenous antibiotics often fail to alleviate the symptoms as this is a closed space and needs prompt drainage. Therefore, awareness of this complication of dental infections is vital for proper diagnosis and timely management.

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.

Assessment of painful symptomology in patients with temporomandibular disorders by means of a combined experimental scale

Quantification and assessment of the evolution of painful symptomology in patients with temporomandibular disorders, during the pre-, trans- and post-therapeutic stages is one of the greatest difficulties found by dental surgeons. Various authors have studied and discussed the use of verbal and non-verbal scales for this purpose. Therefore, this study aimed, by means of a combined experimental scale, to assess the evolution of painful symptomology in patients with completely edentulous maxilla and partly edentulous mandible, with Class I or Class II Kennedy prosthetic spaces, treated with flat occlusal appliances, before, during and after 150 of starting treatment. A selection was made of 16 patients with a mean age of fifty-two years, with signs and symptoms of temporomandibular disorders and diminished vertical occlusion dimension. The patients were submitted to treatment with flat occlusal appliances and fortnightly consultations for a period of 150 days. During these consultations, patients recorded their painful symptomology on a combined experimental pain scale. The results obtained were grouped into tables and submitted to the Friedman Test at a level of 5% probability. These revealed statistically significant differences between the values obtained at each assessment made. According to the methodology used and the results obtained, it was concluded that the therapy used was effective and that the experimental scale was efficient for registering the evolution of the symptoms initially detected.

Infecções odontogênicas oral e maxilo-facial tratadas no HGJAF-Aracaju/SE / Oral and maxillofacial dental infections trated at Governor João Alves Filho Hospital - Aracaju/SE

Dentre os pacientes portadores de infecções odontogênicas internados no HGJAF (1999-2004), foram analisados dados tais como: sexo, idade, procedência, diagnóstico, tratamento, uso de antibiótico, período de internação e evolução. Houve predomínio de pacientes do sexo masculino (57,32%) entre 21 e 30 anos (32,92%, procedentes do interior (54,88%). Abscesso foi a infecção mais frequente (51,22%). O tratamento medicamentoso predominou (62,20%), com uso de antibióticos (100%), mais frequentemente a penicilina (39,71%). Cinco dias foi o período médio de internação, evoluindo para alta hospitalar (98,78%). O tratamento terapêutico-cirúrgico, apesar de não ter sido o mais frequente, é o de escolha, por obter resultados satisfatórios em menor período

Cambios cefalométricos con el uso del activador de Klammt en diferentes magnitudes de protrusión mandibular / Cephalometric changes with the use of Klammt's activator-appliance in different magnitudes of mandibular protrusion

Se realizó un estudio prospectivo durante el año 1999 en 16 niños con maloclusión de clase II división I de Angle, escogidos entre los que acudieron en busca de tratamiento a la Clínica Docente de Santa Clara en el año 1998. Todos usaron el activador abierto elástico de Klammt, pero con diferente magnitud en el avance mandibular: el grupo 1 quedó conformado por pacientes con avance total de la mandíbula y el grupo 2 con un adelantamiento por etapas. Las telerradiografías iniciales y al año, permitieron conocer que en el grupo 1 hubo cambios significativos en la posición mandibular, longitud mandibular y posición de incisivos superiores (p<0,05). En el grupo 2 se observaron estos cambios, pero más marcados (Z con mayor valor absoluto), y aparecen otros como la relación maxilomandibular, la posición del incisivo superior, así como la inclinación y la posición de los incisivos inferiores con respecto a la mandíbula. Concluimos que en ambos grupos hubo cambios significativos en variables esqueléticas y dentarias, pero más marcados y extensos en el grupo con un avance mandibular por etapas(AU)

A prospective study was conducted during 1999 among 16 children with class II division 1 Angle's maloclussion that were selected among those who seeked treatment at the Dental Teaching Clinic of Santa Clara, in 1998. All of them used the open elastic Klammt's activator-appliance, but with a different magnitude in the mandibular advance. Group 1 was composed of patients with total mandibular advance, whereas patients in group 2 presented an advance by stages. The initial teleradiographies and at a year allowed to know that in group 1 there were significant changes in the mandibular position, mandibular length and the position of upper incisors (P<0.05). These changes were more marked in group 2 (Z with a higher absolute value) and there were others as the maxillomandibular relationship, the position of the upper incisor and the inclination and position of the lower incisors in relation to the mandible. It was concluded that in both groups there were significant changes in skeletal and dental variables, but they were more marked and extensive in the group with a mandibular advance by stages(AU)

Avaliaçäo da severidade dos sinais e sintomas das desordens crânio-mandibulares (DCM) de hemiarcos de pacientes edentados unilaterais (Classe II de Kennedy) portadores e näo portadores de prótese parcial removível (PPR) / Evaluation of the severity of the signs and symptoms of craniomandibular disorders (CMD) among hemiarches of unilateral partial edentulous patients (Kennedy's Class II) with and without removable partial dentures (RPD)

Neste estudo, foram examinados clinicamente 68 pacientes, com idades variando entre 18 e 61 anos, com a finalidade de analisar comparativamente a severidade dos sinais e sintomas das desordens crânio-mandibulares (DCM) de hemiarcos de pacientes edentados unilaterais portadores e näo portadores de P.P.R. Para efeito de comparaçäo, utilizou-se ainda um terceiro grupo de 34 pacientes sintomáticos e totalmente dentados. O exame objetivo consistiu no registro e na mensuraçäo através de uma metodologia clínica de escores, cuja finalidade foi comparar as diferenças entre hemiarcos de cada paciente, correspondentes aos seguintes aspectos: a) sensibilidade dolorolosa à palpaçäo dos músculos da mastigaçäo e do pescoço; b) sons articulares e c) sensibilidade dolorosa à palpaçäo da cápsula da articulaçäo temporomandibular (ATM). Foram analisados e comparados estatisticamente todos os dados obtidos, e concluiu-se que os sinais e sintomas dos hemiarcos correspondentes ao lado edentado dos pacientes näo portadores de P.P.R. mostraram grau de severidade significativamente maior quando comparados com os hemiarcos do lado oposto, com a presença de dentes, dos mesmos pacientes. Nos pacientes portadores de P.P.R. e no grupo com todos os dentes no arco, näo houve diferenças significantes entre os respectivos hemiarcos. Como conseqüência, os resultados nos permitiram constatar que a instalaçäo de uma prótese parcial removível (P.P.R.), em pacientes edentados unilaterais, poderá minimizar a severidade dos sinais e sintomas disfuncionais

Disfunçäo craniomandibular (DCM), Parte I: prevalência e necessidade de tratamento / Craniomandibular dysfunction, Part I: prevalence and reed of treatment

Os autores avaliaram a prevalência de Disfunçäo Craniomandibular (DCM) em estudantes de curso pré-universitários e universitários da cidade de Bauru (SP). Foi utilizada uma amostra de 310 estudantes, avaliada através de um questionário anamnésico e história médica. O grau de DCM foi obtido através dos valores do questionário anamnésico e os estudantes classificados em quatro categorias: DCM ausente, leve, moderada ou severa. Como conclusöes, obteve-se que a prevalência de DCM foi de 49,35 por cento (leve), 10,32 por cento (moderada) e 0,97 por cento (severa), obtendo um nível de necessidade de tratamento de 11,29 por cento

Odontodisplasia regional: relato de um caso / Regional odontodysplasia: report of a case

Os autores no presente trabalho apresentam um caso de odontodisplasia regional, em um menino de 9 anos, localizada na mandíbula do lado dereito. Discutem as principais características clínicas e radiográficas associadas ao aparecimento desta patologia