Dehiscences and fenestrations: methodological care necessary to avoid errors in diagnosis and measurement

ABSTRACT The low prevalence of gingival recessions observed in orthodontic clinical practice may be assigned to the fact that in studies in which dehiscences and bone fenestrations are described as frequent, they were diagnosed based on: 1) dry skull studies; 2) areas with periosteal reflection together with flap; and 3) imaging techniques with low sensitivity to detect these defects, which have a delicate structure and function. In areas of pseudo-dehiscences and fenestrations, the periosteum and the alveolar cortical bone are very thin; also, they either have been removed during preparation of the dry specimens in the areas for analysis, or, alternatively, have not been investigated using an ideal imaging method.

RESUMO A ausência de prevalência elevada das recessões gengivais relacionadas à prática clínica ortodôntica se explica, provavelmente, porque, nos trabalhos em que as deiscências e fenestrações ósseas são descritas como frequentes, essas foram diagnosticadas a partir de: 1) estudos em crânios secos; 2) áreas com rebatimento periosteal junto com o retalho; e 3) uso de métodos imagiológicos que falham em sensibilidade para captá-las, pela sua delicadeza estrutural e funcional. Nessas áreas de pseudodeiscências e fenestrações, existe periósteo e cortical óssea alveolar muito fina, que foram eliminados nos procedimentos de preparação dos espécimes secos, nas áreas para a análise ou, então, não se aplicou um método imagiológico ideal.

Palatal Pleomorphic Adenoma in a Pediatric Patient: Case Report / Adenoma Pleomorfo Palatino en un Paciente Pediátrico: Reporte de Caso

Pleomorphic adenoma is the most common benign neoplasm of salivary glands. Their common location is in parotid gland, however, a lower percentage of these tumors might occur in minor glands. The epidemiology of this tumor shows that adults are the most affected, with rare occurrence in children or adolescents. We present the case report of pleomorphic adenoma located on the palate of a 10 year old. Excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed ductal structures surrounded by plasmacytoid mioepithelial cells within a myxoid stroma, the final diagnosis corresponded to Pleomorphic Adenoma. Early detection and excision of this lesion in children are important to minimize potential recurrences or malignant transformation.

El adenoma pleomorfo es la neoplasia benigna más común de las glándulas salivales. Su localización común está en glándula parótida, sin embargo, un bajo porcentaje de estos tumores puede ocurrir en glándulas menores. La epidemiología de este tumor muestra que los adultos son los más afectados, con rara ocurrencia en niños o adolescentes. Presentamos el caso de un adenoma pleomorfo localizado en el paladar de un niño de 10 años. La biopsia excisional de la lesión seguida de examen histopatológico de la muestra de biopsia reveló estructuras ductales rodeadas por células mioepiteliales plasmocitóides dentro de un estroma mixoide, siendo el diagnóstico final adenoma pleomorfo. La detección temprana y la excisión de esta lesión en los niños es importante para minimizar las recidivas potenciales o la transformación maligna.

Abscesso subperiosteal com extensão epidural devido à rinossinusite aguda em criança de dez anos / Subperiosteal abscess with epidural extension due to acute rhinosinusitis in a ten-year-old child

RESUMO A rinossinusite aguda é uma das afecções mais prevalentes das vias aéreas superiores. Fatores anatômicos presentes em crianças e jovens propiciam o aparecimento de complicações orbitárias. Embora mais raras, as complicações intracranianas das rinossinusites perfazem um grau alto de letalidade, são mais comuns em pacientes acima de sete anos, e devem ser tratadas por uma equipe multidisciplinar.

ABSTRACT Acute rhinosinusitis is one of the most prevalent diseases of the upper airways. Anatomical factors present in children and young people allow for the onset of orbital complications. Although rare, intracranial complications of sinusitis account for a high degree of lethality, are more common in patients over the age of seven, and should be treated by a multidisciplinary team.

Tratamento cirúrgico da paquidermoperiostose primária - relato de dois casos / Surgical Treatment of Primary Pachydermoperiostosis: Report of Two Cases / Surgical Treatment of Primary Pachydermoperiostosis: Report of Two Cases

A paquidermoperiostose primária é uma doença rara, caracterizada por aposição excessiva do periósteo do crânio, coexistindo com espessamento da epiderme e derme (paquidermia), provocando deformidades grosseiras. Devido à diversidade de estruturas acometidas, há várias opções cirúrgicas e métodos complementares que são utilizados no tratamento das alterações faciais desses pacientes. Esse trabalho apresenta o lifting subperiosteal como uma opção de tratamento estético para a face de pacientes portadores dessa síndrome, através do relato de dois casos operados no Hospital das Clínicas da Universidade Federal de Minas Gerais.

Primary pachydermoperiostosis is a rare disease characterized by excessive skull affixing of the periosteum, coexisting with thickening of the epidermis and dermis (pachydermia), thereby causing gross deformities. Owing to the variety of affected structures, there are several surgical options and complementary methods that are used in the treatment of facial alterations in these patients. This report describes the use of subperiosteal detachment as an aesthetic treatment option for the faces of two patients with primary pachydermoperiostosis, operated at the Hospital das Clínicas of the Federal University of Minas Gerais.

Role of tricalcium phosphate implant in bridging the large osteoperiosteal gaps in rabbits.

Treatment options for large osteoperiosteal defects are limited and that which are available are not ideal. Osteoperiosteal defect were created in ulnae of both forelimbs of rabbits and tricalcium phosphate implant was used to bridge the gap. Amongst the 35 implanted ulnae, one implant got dislodged. Rest of the implants showed good adherence to host bone until the final follow up. Five control rabbit limbs (in which no implants were put) showed persistent bone gap. Histological and Electron microscopic examination revealed bone tissues covering the surface of the implant and bridging the gap. New bone was formed in the pores also. Tricalcium phosphate implants showed new bone formation due to osteoconductive properties. They are biodegradable. It is suggested that tricalcium phosphate implants are viable treatment alternatives in management of large osteoperiosteal defects with minimal to no adverse effects.

Disturbed Osteoblastic Differentiation of Fibrous Hamartoma Cell from Congenital Pseudarthrosis of the Tibia Associated with Neurofibromatosis Type I

BACKGROUND: Fibrous hamartoma is the key pathology of congenital pseudarthrosis of the tibia (CPT), which was shown to have low osteogenicity and high osteoclastogenicity. This study further investigated the mechanism of impaired osteoblastic differentiation of fibrous hamartoma cells. METHODS: Fibroblast-like cells were obtained from enzymatically dissociated fibrous hamartomas of 11 patients with CPT associated with neurofibromatosis type I (NF1). Periosteal cells were also obtained from the distal tibial periosteum of 3 patients without CPT or NF1 as control. The mRNA levels of Wnt ligands and their canonical receptors, such as Lrp5 and beta-catenin, were assayed using reverse transcriptase PCR (RT-PCR). Changes in mRNA expression of osteoblast marker genes by rhBMP2 treatment were assayed using quantitative real time RT-PCR. Changes in mRNA expression of transcription factors specifically involved in osteoblastic differentiation by rhBMP2 treatment was also assayed using quantitative real-time RT-PCR. RESULTS: Wnt1 and Wnt3a mRNA expression was lower in fibrous hamartoma than in tibial periosteal cells, but their canonical receptors did not show significant difference. Response of osteoblastic marker gene expression to rhBMP2 treatment showed patient-to-patient variability. Col1a1 mRNA expression was up-regulated in most fibrous hamartoma tissues, osteocalcin was up-regulated in a small number of patients, and ALP expression was down-regulated in most fibrous hamartoma tissues. Changes in mRNA expression of the transcription factors in response to rhBMP2 also showed factor-to-factor and patient-to-patient variability. Dlx5 was consistently up-regulated by rhBMP2 treatment in all fibrous hamartoma tissues tested. Msx2 expression was down-regulated by rhBMP2 in most cases but by lesser extent than control tissue. Runx2 expression was up-regulated in 8 out of 18 fibrous hamartoma tissues tested. Osterix expression was up-regulated in 2 and down-regulated in 3 fibrous hamartoma tissues. CONCLUSIONS: Congenital pseudarthrosis of the tibia appears to be caused by fibrous hamartoma originating from aberrant growth of Nf1 haploinsufficient periosteal cells, which failed in terminal osteoblastic differentiation and arrested at a certain stage of this process. This pathomechanism of CPT should be targeted in the development of novel therapeutic biologic intervention.

Unusual rib tumor: parosteal lipoma with extensive osteochondromatous metaplasia.

Lipomas of the bone usually occur in the long bones and are seen in the fifth to seventh decade of life. Rib lipomas are rare and those having parosteal location are even rarer. We report a case of parosteal lipoma of the rib in a young male with some unique features. This is the fifth case of its kind to be reported in literature.

[Intramuscular haemangioma of the forearm with radial and ulnar periosteal reaction [Report of one case]]

We present a rare case of intramuscular Haemangioma of the forearm with periosteal reaction of radius and ulna. A 38-year-old female presented with a tumefaction in distal and dorsoulnar side of the right forearm. She had 1.5 years history of tumor which was painful during resent 2 months. Plain x-ray and MRI was done and the diagnosis of Haemangioma was proved by open biopsy. The tumor plus periosteal reaction and enlarged bone was respected. After 4 years follow-up no recurrence was seen

Influence of simvastatin on bone regeneration of tibial defects and blood cholesterol level in rats

The purpose of this study was to evaluate the effects of simvastatin, by oral or subcutaneous administration, on tibial defects regeneration and blood cholesterol level in rats. A surgical defect was made on the right tibia of 40 male animals assigned to 4 groups (n=10), based on two routes of administration and on the use or not of simvastatin: subcutaneous injection of simvastatin (7 mg/kg) (group AT) or only the vehicle of drug suspension (group AC), above the defect area, for 5 days; and 20 mg/kg of simvastatin macerated on water (group BT) or only water (group BC), orally, daily, during the whole observation period. The animals were sacrificed after 15 or 30 days, when blood samples were analyzed to check plasma cholesterol levels. Tibiae were removed and, after decalcification and routine laboratorial processing, histological and histomorphometrical analyses were carried out. ANOVA was used for statistical analysis at 5 percent signficance level. The histological and histomorphometrical analyses showed significant differences only between the experimental periods (p<0.05). Animals sacrificed after 30 days showed better bone repair (p<0.05). There was no statistically significant difference (p>0.05) for blood cholesterol levels between the groups. In conclusion, simvastatin administration either orally or subcutaneously did not improve bone repair of experimental tibial defects and did not alter blood cholesterol levels in rats.

Este estudo avaliou a influência da sinvastatina, administrada por via oral ou subcutânea, na reparação de defeitos ósseos em tíbia e nos níveis de colesterol sangüíneo, em ratos. Foram realizados defeitos cirúrgicos nas tíbias direitas de 40 ratos machos, distribuídos em 4 grupos (n=10), tomando-se como base duas vias de administração e o uso ou não de sinvastatina: injeção subcutânea de sinvastatina (7 mg/kg) (grupo AT) ou apenas do veículo de suspensão da droga (grupo AC), sobre a região do defeito, durante 5 dias; 20 mg/kg de sinvastatina (grupo BT) ou água filtrada (grupo BC) via oral, diariamente, durante todo o período de observação. Os animais foram sacrificados após 15 ou 30 dias, quando amostras sangüíneas foram colhidas para análise do nível de colesterol. As tíbias foram removidas e, após descalcificação e procedimentos laboratoriais de rotina, procedeu-se à análise histológica e histomorfométrica. Para avaliação estatística utilizou-se ANOVA com nível de significância de 5 por cento. As análises histomorfométrica e histológica mostraram diferença entre os grupos apenas com relação ao período experimental (p<0,05), apresentando os melhores resultados os animais sacrificados em 30 dias (p<0,05). Quanto ao nível de colesterol sangüíneo, não houve diferença estatisticamente significante entre os grupos analisados (p>0,05). Concluiu-se que, nas condições utilizadas, a sinvastatina, administrada via oral ou subcutânea, não exerceu efeito estimulador sobre o reparo ósseo de defeitos experimentais em tíbias de ratos e não alterou os níveis de colesterol sangüíneo.

Traumatic bilateral intraorbital (subperiosteal) hematoma associated with epidural hematoma: case report

Extradural hematoma (EDH) is a frequent lesion, with an incidence varying from 0.2 to 6 percent in patients admitted to hospital due to traumatic head injury. The higher incidence is found in patients with more severe injuries. The association of EDH with subperiosteal intraorbital hematomas is rarely reported, and we were not able to find in the literature any report of traumatic bilateral intraorbital hematomas and EDH. We report this case of a 32 year-old man with bilateral intraorbital (subperiosteal) hematoma associated with unilateral EDH. The lesions were treated surgically, but unfortunately with an unfavorable outcome

Cisto subperiostal por neurofibromatose de von Recklinghausen / Subperiosteal cyst in von RecklinghausenÆs neurofibromatosis

Os autores apresentam raro caso de manifestação óssea da neurofibromatose de von Recklinghausen em doente de 9 anos de idade do sexo feminino, com acentuado aumento de volume do membro inferior esquerdo com caracteres de elefantíase e história pregressa de seis meses de dor com progressiva dificuldade à deambulação. Amputado, em virtude da impossibilidade de tratamento cirúrgico conservador. Ao exame radiográfico o periósteo da tíbia estava completamente descolado, delimitando grande abaulamento tumoral. O exame anatomopatológico evidenciou coleção líquida que envolvia a tíbia externamente delimitada pelo periósteo, transformado em espessa faixa fibrosa com áreas de ossificação metaplásica. Nas extremidades existiam neuromas plexiformes da doença de von Recklinghausen. Os autores discutem a patogenia e tecem considerações sobre a conduta terapêutica.

Estudo histopatológico do comportamento do periósteo frente a estímulo cirúrgico, em ratos / Histopathological study of periosteum behavior apropos of surgical stimulus in rats

Foi estudado, em níveis histológicos de microscopia ótica e em ratos, as modificaçöes ocorridas no periósteo do osso alveolar e tecidos adjacentes, quando submetidos a um estímulo cirúrgico mecânico. Foram observadas mudanças marcantes quantitativas e qualitativas no periósteo e, depois de algum tempo, deposiçäo de tecido ósseo

Participaçäo do periósteo na cicatrizaçäo de enxerto gengival livre colocado sobre osso exposto / Participation of the periosteum in the healing of free gingival graft placed over the exposed bone

Um estudo histológico em cäes foi executado para analisar a seqüência da cicatrizaçäo, quando enxerto gengival livre é colocado diretamente sobre o osso cortical, utilizando-se retalho total (mucoperiósteo) no preparo do leito. A origem dos recentemente formados tecidos necessários para fixar o enxerto ao osso cortical, é sugerido ser o periósteo localizado perifericamente, além do jovem tecido de granulaçäo vindo dos espaços medulares expostos, e do ligamento periodontal. A preparaçäo cirúrgica da área receptora poderia ser responsável pela extensa reabsorçäo óssea que poderia ocorrer