Tumor odontogénico adenomatoide. Reporte de un caso clínico / Adenomatoid odontogenic tumor. Clinical case report

El Tumor Odontogénico Adenomatoide (TOA) es una neoplasia benigna poco común, caracterizada por un crecimiento lento y progresivo, en la mayoría de los casos asintomático. Es una patología intraósea, que puede ser folicular o extrafolicular, siendo el tipo folicular el más común. Se presenta en hombres y mujeres, con predilección por el sexo femenino. Histológicamente está compuesto por epitelio odontogénico organizado en distintos patrones histoarquitectónicos, incrustado en un estroma de tejido fibroconectivo maduro. Se describe el caso clínico de una paciente femenina de 25 años, con aumento de volumen en la región maxilar anterior izquierda, que se extiende a la base de la nariz, produce desvío de la línea media a la derecha y tiene un año de evolución.

The Adenomatoid Odontogenic Tumor (AOT) is an uncommon benign neoplasm, characterized by slow and progressive growth, in most cases asymptomatic. It is an intraosseous pathology, which can be follicular or extrafollicular, with the follicular type being the most common. It occurs in both men and women, with a predilection for the female sex. Histologically, it is composed of odontogenic epithelium organized in different histoarchitectonic patterns, embedded in a stroma of mature fibroconnective tissue. We describe the clinical case of a 25-year-old female patient with increased volume in the left anterior maxillary region, extending to the base of the nose, causing deviation of the midline to the right and having one year of evolution.

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

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

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

Defecto oncológico maxilar reconstruido mediante colgajo de músculo temporal / Maxillary oncologic defect reconstructed with temporal muscle flap / Defeito oncológico maxilar reconstruído por aba muscular temporal

El macizo facial es una región anatómica compleja que alberga órganos sensoriales. El desarrollo de una enfermedad oncológica, así como su tratamiento, causan defectos funcionales y estéticos con un alto costo físico y psíquico para el paciente y su entorno. Es por ello que la reconstrucción representa un reto. Las diferentes posibilidades incluyen prótesis obturatríces, colgajos libres, pediculados o microvascularizados. En este artículo se describirá el colgajo de músculo temporal y se desarrolla un caso clínico de cirugía oncológica maxilar reconstruido mediante éste en un paciente que presenta una lesión exofítica en cuadrante superior derecho, que se extiende sobre el flanco vestibular, reborde alveolar y zona palatina, desde zona de premolares hasta la zona del segundo molar inclusive, impidiéndole usar la prótesis dental. Esta cirugía es una técnica económica, que requiere menor tiempo quirúrgico que otras técnicas, asociándose a poco porcentaje de fracaso y pocas complicaciones post operatorias.

The facial mass is a complex anatomical region that houses sensory organs. The development of an oncologic disease, as well as its treatment, causes functional and esthetic defects with a high physical and psychological cost for the patient and his environment. This is why reconstruction represents a challenge. The different possibilities include obturator-root prostheses, free, pedicled or microvascularized flaps. In this article the temporal muscle flap will be described and a clinical case of maxillary oncologic surgery reconstructed by means of it is developed in a patient who presents an exophytic lesion in the right upper quadrant, which extends over the vestibular flank, alveolar ridge and palatal area, from the premolar area up to and including the second molar area, preventing him from using the dental prosthesis. This surgery is an economical technique that requires less surgical time than other techniques, and is ass

A massa facial é uma região anatômica complexa que abriga órgãos sensoriais. O desenvolvimento de uma doença oncológica, assim como seu tratamento, causa defeitos funcionais e estéticos com alto custo físico e psicológico para o paciente e seu ambiente. A reconstrução é, portanto, um desafio. As diferentes possibilidades incluem as próteses de raiz obturadora, abas livres, pediculadas ou microvascularizadas. Este artigo descreve o retalho muscular temporal e descreve um caso clínico de cirurgia oncológica maxilar reconstruída utilizando-o em um paciente com lesão exofítica no quadrante superior direito, estendendo-se pelo flanco vestibular, rebordo alveolar e área palatina, desde a área do pré-molar até a área do segundo molar inclusive, impedindo-o de utilizar a prótese dentária. Esta cirurgia é uma técnica econômica, que requer menos tempo cirúrgico que outras.

Quality of Life and Maxillary Defects: A Cross-Sectional Study / Calidad de Vida y Defectos Maxilares: Un Estudio Transversal

ABSTRACT: There has been little discussion about the quality of life of patients with maxillary defects. This article evaluates the issues related to the condition. We performed a cross-sectional study of patients with maxillary defects from referral centers in Brazil. To avoid subject burden, a questionnaire was developed, based on questions from seven instruments, which dealt with domains and conclusions that were similar to those from other studies. The predictor variable was the patients' score for each question. The outcome measure was the presence of the best-ranked items on the questionnaire as the impact factor. Six experts assessed these items and suggested which questions to include or exclude. Patients scored each item according to its occurrence and importance. Descriptive statistics and the items' rank according to the impact factor were computed to determine whether there is a comprehensive instrument available. Thirteen patients and six professionals were included in this study. The patients' age ranged from 24 to 72 years (mean (standard deviation, SD), 50.41 (14.46) years). We obtained a 60-item instrument from the selected questionnaires and subject interviews. Only 12 (37.5 %) out of the 32 best-rated items were verified by the existing instruments, two (6.25 %) were suggested by professionals and 18 (56.25 %) were conclusions from other studies. To the best of our knowledge, this is the first study to provide many features related to the quality of life in patients with maxillary defects.

RESUMEN: Existe escasa discusión en la literatura sobre la calidad de vida de los pacientes con defectos maxilares. Este artículo evalúa los problemas relacionados con esta condición. Realizamos un estudio transversal de pacientes con defectos maxilares de centros de referencia en Brasil. Se desarrolló un cuestionario basado en preguntas de siete instrumentos, que trataba sobre dominios y conclusiones similares a las de otros estudios. La variable de estimación fue la puntuación de los pacientes para cada pregunta. La medida de resultado fue la presencia de los elementos mejor clasificados en el cuestionario como factor de impacto. Seis expertos evaluaron estos ítems y sugirieron qué preguntas incluir o excluir. Los pacientes puntuaron cada ítem según su ocurrencia e importancia. Se calcularon las estadísticas descriptivas y la clasificación de los ítems según el factor de impacto, para determinar si existe un instrumento completo. Trece pacientes y seis profesionales fueron incluidos en este estudio. La edad de los pacientes osciló entre 24 y 72 años [media (desviación estándar), 50,41 (14,46) años]. Obtuvimos un instrumento de 60 ítems de los cuestionarios y entrevistas de temas seleccionados. Solo 12 (37,5 %) de los 32 ítems mejor calificados se verificaron de acuerdo a los instrumentos existentes, dos (6,25 %) fueron sugeridos por profesionales y 18 (56,25 %) fueron conclusiones de otros estudios. De acuerdo a nuestro conocimiento, este es el primer estudio que proporciona características relacionadas con la calidad de vida en pacientes con defectos maxilares.

Clinical study of free anterolateral thigh perforator flap in repairing maxillary complex tissue defects / 肿瘤研究与临床

Objective To explore the effect of free anterolateral thigh (ALT) perforator flap in the repairment of complex maxillary defects. Methods The clinical data of 51 patients undergoing the reconstruction of maxillary defects in ALT perforator flap between January 2013 and October 2016 in the Peking University Hospital of Stomatology were retrospectively analyzed. All the patients received ALT reconstruction during the maxillary tumor resection. Results Four patients had blood vessel crisis after surgery in 51 cases. Two cases were removed due to flap necrosis, and 49 cases survived with a satisfactory appearance and function, and the overall flap survival rate of 49 cases was 96.08 ％ (49/51). Conclusion ALT perforator flap provides an ideal reconstruction for complex maxillary defects with a well-restored function in the surgical ares which could avoid the facial asymmetry and contribute to the following treatment.

Clinical and immunohistochemical study of melanotic neuroectodermal tumor of infancy in the maxilla / Estudo clínico e imuno-histoquímico de tumor neuroectodérmico melanocítico da infância em maxila

ABSTRACT Melanotic neuroectodermal tumor of infancy is a rare and fast-growing neoplasm. In this study, we describe the case of a 6-month-old female patient, who presented swelling in the anterior maxilla. Tomographic reconstruction showed an unilocular hypodense and expansive area associated with the upper right central primary incisor. The presumptive diagnoses were dentigerous cyst, adenomatoid odontogenic tumor, melanotic neuroectodermal tumor of infancy and rhabdomyosarcoma, and an incisional biopsy was performed. Microscopically, the lesion revealed a biphasic cell population, consisting of small, ovoid, neuroblastic-like cells and epithelioid cells containing melanin. Immunohistochemically, the melanocyte-like component was strongly and diffusely positive for HMB-45 and Melan-A, but weakly positive for S100. Based on these findings, definitive diagnosis of melanotic neuroectodermal tumor of infancy was established. Then, enucleation of the lesion was performed by careful curettage. After 2 year follow-up, no clinical or radiographical evidence of recurrence was verified. The present case highlights the importance of early diagnosis and therapeutic intervention at the appropriate time to achieve a favorable outcome for the patient.

RESUMO O tumor neuroectodérmico melanocítico da infância é uma neoplasia rara e de crescimento rápido. Neste estudo, relata-se o caso de uma paciente do sexo feminino de 6 meses de idade, que apresentou tumefação na região anterior de maxila. A reconstrução tomográfica revelou área unilocular hipodensa e expansiva associada ao incisivo central superior direito decíduo. Realizou-se biópsia incisional, considerando as hipóteses diagnósticas de cisto dentígero, tumor odontogênico adenomatoide, tumor neuroectodérmico melanocítico da infância e rabdomiossarcoma. Microscopicamente, a lesão revelou população celular bifásica, consistindo de células pequenas, ovoides, de aparência neuroblástica, e de células epitelioides, contendo melanina. A análise imuno-histoquímica demonstrou que o componente celular contendo melanina era positivo de forma intensa e difusa para HMB-45 e Melan-A, mas levemente positivo para S100. Com base nestes achados, foi estabelecido o diagnóstico definitivo de tumor neuroectodérmico melanocítico da infância. Em seguida, foi realizada a enucleação da lesão com curetagem cuidadosa. Após 2 anos de acompanhamento, não foram verificadas evidências clínicas ou radiográficas de recorrência. O presente caso destaca a importância do diagnóstico precoce e da intervenção terapêutica no momento apropriado, a fim de alcançar um desfecho favorável para o paciente.

Enucleação associada à solução de Carnoy no tratamento de tumor odontogênico ceratocístico / Enucleation associated to Carnoy's solution on treatment of keratocistic odontogenic tumor

Tumor Odontogênico Ceratocístico (TOC) é classificado como uma lesão intraóssea benigna, de origem odontogênica. Apresenta comportamento biológico agressivo e alta taxa de recidiva. Por sua heterogeneidade clínica e histológica, gera controvérsias em relação ao tipo de tratamento. Técnicas, como marsupialização, descompressão, enucleação, ou mesmo, ressecção cirúrgica, são algumas opções de tratamento, podendo associar com outras formas de terapias. O presente trabalho tem por objetivo relatar o caso de um paciente do gênero masculino que apresentava lesão osteolítica na região posterior direita da mandíbula, diagnosticada como tumor odontogênico ceratocístico. O tratamento proposto foi enucleação associada à aplicação de solução de Carnoy. Após 4 anos de pós-operatório, a técnica cirúrgica associada à terapia química mostrou-se eficaz, apresentando resultados satisfatórios. O paciente segue em acompanhamento, sem referir queixas álgicas e funcionais, além de não apresentar alterações estéticas... (AU)

Keratocystic odontogenic tumor is classified as a benign intraosseous and odontogenic lesion. It presents an aggressive biological behavior and great tendency to relapse. Also, it is a pathology that is noteworthy due to its clinical and histological heterogeneity. This diversity reflects on controversies in defining the adequate treatment for these lesions, opting for surgical techniques such as marsupialization, enucleation or resection, even associate with other conservative treatment. By upgrading the knowledge of cell biology, development of diagnostic tests and the improvement of surgical techniques, the treatment of oral diseases suffered major changes in recent decades, making it safer and leading to more predictable results. This study aims to report the case of a male patient, suffering from osteolytic lesion in the posterior mandible, diagnosed as keratocystic odontogenic tumor, which was treated by enucleation associated to application of Carnoy's solution, which is an alternative treatment already described. After 4 years follow-up, proposed treatment has been shown efficient presenting satisfactory results. Patient remains accompanied with no pain and functional complaints as well as no aesthetics alterations... (AU)

Clinical analysis of cervical lymph node metastasis of cN0 maxillary malignant tumor / 北京大学学报(医学版)

Objective:To investigate the cervical lymphatic metastasis rates of clinically negative neck lymph node (cN0) maxillary malignant tumors,to compare the cervical lymphatic metastasis rates of the various pathological types,and to provide the reference for the treatment of the neck of the patients with cN0 maxillary malignant tumor.Methods:The clinical data of 277 cases with cN0 maxillary malignant tumor,treated in the department of oral and maxillofacial surgery of Peking University School and Hospital of Stomatology from 1990 to 2010,were reviewed.The cervical lymph node metastasis and the related clinical information were recorded.The clinical information including histopathology type of the tumors,tumor grade,primary site and TNM staging,as well as other demographic and clinical data,were retrieved from the electronic medical record system (EMRS) of the hospital.The pathogenesis of cervical lymph node metastasis in maxillary malignant tumors of different histopathological types,and the factors related to lymph node metastasis of upper cervical malignancy were analyzed by SPSS 19.0 statistical software.Results:The overall cervical lymph node metastasis rate of the 277 patients with cN0 maxillary malignant tumor was 15.5％ (43/277).Maxillary squamous cell carcinoma (SCC) had a strong cervical lymph node metastasis tendency and the rate was 33.0％.The overall metastatic rate of adenocarcinoma was 7.6％ lower than that of SCC,and the occurrence of cervical lymph node metastasis time was relatively late,but the metastasis rate of highly malignant grade salivary gland carcinoma was significantly higher than that of intermediate and low grade carcinoma (P =0.037).The metastatic rates of some highly malignant cN0 salivary gland carcinomas including adenocarcinoma,not other specified,high-grade mucoepidermoid carcinoma (MEC),and salivary duct carcinoma were exceeded 15％,while the metastasis rates of adenoid cystic carcinoma and myoepithelial carcinoma were lower.The metastasis rate of the sarcomas was very low with the rate of 4.9％.Conclusion:Selective neck dissection (SND) is recommended for cN0 maxillary SCC and feasible for some highly malignant cN0 salivary gland carcinomas including adenocarcinoma,not other specified,high-grade MEC,salivary duct carcinoma.The neck can be closely observed for the patients with maxillary sarcoma.

Fibrosarcoma ameloblástico en la mandíbula / Ameloblastic fibrosarcoma arising in the mandible

Ameloblastic fibrosarcoma is a rare odontogenic neoplasm and is considered the malignant counterpart of ameloblastic fibroma. The diagnosis is made by histopathological and immunohistochemical evaluation, since the epithelial component remains benign and the mesenchymal component becomes malignant. Until 2012, only 72 cases were published in English-literature. This article presents a case of intraoral mass at the posterior mandible of a 23 year-old female patient. Panoramic radiography showed a multilocular radiolucent lesion with ill-defined borders and tooth involvement. The mandibular canal presented loss of architecture also. The computed tomography images (bone window) showed hypodense lesion leading to expansion, tapering and irregular destruction of cortical, and tooth involvement. Incisional biopsy was performed for histopathological evaluation. The results revealed a mixed lesion with epithelial and mesenchymal cellular proliferation. At immunohistochemical analysis, the mesenchymal portion was vimentin positive and the epithelial component was positive for cytokeratin AE1-AE3. It also showed p53 intense labeling in all tumorous cells. The final diagnosis was ameloblastic fibrosarcoma. The lesion was surgically excised with clear margins. The radiographic appearance, even imperative for treatment planning, poorly contributed to final diagnosis, which was reached by histopathological and immunohistochemical evaluations. The treatment is still controversial, without a definition regarding chemotherapy and radiotherapy as coadjutant treatment(AU)

El fibrosarcoma ameloblástico es una neoplasia odontogénica poco frecuente y es considerada la contraparte maligna del fibroma ameloblástico. El diagnóstico se realiza mediante la evaluación histopatológica e inmunohistoquímica, ya que el componente epitelial sigue siendo benigno y el componente mesenquimal se convierte en maligno. Hasta 2012, solo 72 casos fueron publicados en la literatura inglesa. En este artículo se presenta un caso de masa intraoral en la mandíbula parte posterior, de una paciente de 23 años de edad. La radiografía panorámica mostró una lesión radiolúcida multilocular con bordes mal definidos y con un diente incluso en la lesión. El canal mandibular también presentaba pérdida de la arquitectura. La tomografía computarizada (TC) (ventana de hueso) presentó lesión hipodensa que provocaba una expansión que se estrechaba y destruía irregularmente la cortical, además envolvía la pieza dentaria. Se realizó biopsia incisional para evaluación histopatológica. Los resultados revelaron una lesión mixta con proliferación celular epitelial y mesenquimal. En el análisis inmunohistoquímico, la porción mesenquimal fue positivo para vimentina y el componente epitelial fue positivo para citoqueratina AE1-AE3. También mostró marcación intensa para p53 en todas las células tumorales. El diagnóstico final fue de fibrosarcoma ameloblástico. La lesión fue extirpada quirúrgicamente con márgenes de seguridad. El aspecto radiológico, aunque imprescindible para la planificación del tratamiento, poco contribuyó al diagnóstico final, que fue alcanzado por las evaluaciones histopatológicas e inmunohistoquímicas. El tratamiento sigue siendo controvertido, sin una definición respecto de la quimioterapia y la radioterapia como tratamiento coadyuvante(AU)

Abordagem conservadora para extenso tumor odontogênico ceratocístico mandibular / Conservative approach for large mandibular keratocyst odontogenic tumor

O Tumor Odontogênico Ceratocístico (TOC), cuja prevalência varia entre 10% e 12% de todos os cistos e tumores odontogênicos, permanece uma entidade controversa e de opções de tratamento bastante variadas. As altas taxas de recidiva associadas tornam difícil a decisão sobre a abordagem terapêutica ideal. Em contraste com as opções terapêuticas agressivas, como a ressecção parcial, que, apesar de menor risco de recidiva, repercutem em déficits estéticos e funcionais extensos, atualmente ganham destaque as opções terapêuticas conservadoras, de fácil execução e morbidade mínima ao paciente. O objetivo deste artigo compreende discutir a viabilidade de emprego de técnica conservadora para abordagem de tais lesões mediante relato de caso clínico de extenso TOC em mandíbula... (AU)

The keratocystic odontogenic tumor (KOT), which prevalence ranges from 10% to 12% of all odontogenic cysts and tumors, remains a controversial pathology about treatment options. The high recurrence rates make it difficult to decide the optimal therapeutic approach. Aggressive treatment options such as partial resection are associated with lower risk of recurrence, but may cause extensive aesthetic and functional deficits. Conservative treatment options have shown up as definitive treatment with good results, simple technique and minimal patient morbidity. This paper discuss the feasibility of conservative technique usage for such kind ofpathology approach through a case report of extensive mandibular KOT... (AU)

Biografía médica de Sigmund Freud / Medical biography of Sigmund Freud

Sigmund Freud nació en Freiberg, Moravia, el 6 de mayo de 1856 en una familia judía. Sus padres se trasladaron a Viena dos años después. Fue en esa ciudad donde el joven Freud estudió Medicina, inclinándose en primera instancia, con Brücke, hacia la investigación en neurología. Su matrimonio con Martha Bernays lo decidió a ejercer privadamente la psiquiatría, luego de frecuentar las clínicas de Meynert, de Charcot y de Breuer. Con este último publicó La interpretación de los sueños en 1900. Entre las numerosas enfermedades que padeció, destacamos jaquecas pulsátiles, amigdalitis, otitis, rinosinusitis, tifoidea, viruela, arritmia cardíaca, neumonía, reumatismo, ciática, colon irritable y prostatismo. De siempre fumador de cigarros, el tumor maxilar que lo llevó a la muerte comenzó en 1923 y se desarrolló inexorablemente durante los siguientes 16 años, motivando la realización de 34 intervenciones quirúrgicas y variadas aplicaciones locales de radio, al igual que sesiones de radioterapia externa. Los mejores médicos europeos de los comienzos del siglo XX lo asistieron en su torturante calvario. Una revisión moderna de las placas histopatológicas conservadas en el Instituto Curie de París, permite afirmar que lo que Freud realmente tuvo fue un carcinoma verrugoso, entidad descrita por Lauren Ackerman, de St. Louis, Missouri, en 1948, es decir nueve años después de la muerte del genio...

Effect of primary site for oral and maxillary squamous cell carcinoma on location of neck node metastasis / 北京大学学报(医学版)

Objective:To analyze the predilection of metastasis at levels Ⅰ,Ⅱ,Ⅲ, Ⅳ,Ⅴfor oral and maxillary squamous cell carcinoma on different primary sites .Methods: A retrospective review was conducted of the records of 1 233 patients ( 1 340 necks ) from January 2000 to December 2011 with squamous cell carcinoma simultaneously underwent primary tumor resection and neck dissection in De -partment of Oral and Maxillary Surgery , Peking University School and Hospital of Stomatology .The to-pography of positive neck node was recorded , and the calculation was performed for the metastasis rate of levels Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴbased on the primary site , respectively .Results:There were 557 necks with positive node (41.57%), and the metastasis rate for level Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴ were 27.61%, 22.91%, 9.18%, 4.99%, 3.24%, respectively.Those in level Ⅲ were at high risk for metastasis from carcinoma of tongue and the floor of mouth .The positive rate in level Ⅱwas more than that in levelⅠfor tongue carcinoma , but for inferior gingiva carcinoma , bucca carcinoma , upper gingiva carcinoma , palatine carcinoma , maxillary sinuse carcinoma , intraosseous carcinoma of mandibular , the positive node was more likely to happen at level Ⅰcompared with level Ⅱ.Conclusion: Most metastases happen in levels Ⅰ-Ⅲfor patients with oral and maxillary squamous cell carcinoma , but the predilection of metas-tasis in level Ⅰ,ⅡorⅢis varied with the primary sites .

Estudo demográfico, clínico e terapêutico do ameloblastoma: análise de 40 casos / Ameloblastoma demographic, clinical and treatment study: analysis of 40 cases

As lesões odontogênicas representam cerca de 1% dos tumores da cavidade bucal, sendo o ameloblastoma a afecção mais frequente. Trata-se de um tumor de origem epitelial, que afeta principalmente a mandíbula e, raramente, a maxila. Clinicamente, apresenta-se como tumor de crescimento lento, assintomático. Apesar de ser um tumor benigno, cursa com comportamento invasivo com alta taxa de recidiva, se não tratado adequadamente. OBJETIVO: Descrever os casos de ameloblastoma em serviço de referência. MÉTODOS: Análise retrospectiva de 40 casos. As variáveis analisadas foram: idade, gênero, etnia, localização do tumor, tipo de tratamento, complicação e recorrência. RESULTADOS: O gênero mais atingido foi o masculino, 21 casos (52,5%), com predomínio da etnia caucasiana - 24 casos (60%). A média de idade foi de 35,45 anos, a localização mais comum foi na mandíbula - 37 casos (92,5%). Assimetria facial a queixa mais frequente. Dos 40 casos, 33 foram submetidos a procedimento cirúrgico. Dos que tiveram tratamento cirúrgico, 24 (72,72%) foram submetidos à ressecção segmentar, com recidiva em quatro (12,12%) casos. CONCLUSÃO:O ameloblastoma apresenta possibilidade de recidiva quando o tratamento cirúrgico não é realizado com ressecção ampla da lesão com margens de segurança.

Dental lesions represent about 1% of oral cavity tumors being ameloblastoma the most common one. It is a tumor of epithelial origin that mainly affects the jaw, and less commonly the maxilla. Its clinical presentation is that of an asymptomatic slow-growing tumor. Despite being a benign tumor, it has an invasive behavior with a high rate of recurrence if not treated properly. OBJECTIVE: To describe the cases of ameloblastoma in a reference department. METHODS: Retrospective analysis of 40 cases. The variables analyzed were: age, gender, ethnicity, tumor location, type of treatment, complications and recurrence. RESULTS: The most affected gender was male - 21 cases (52.5%); with a predominance of Caucasians - 24 cases (60%). The mean age was 35.45 years; the most common location was in the jaw - 37 cases (92.5%). Facial asymmetry was the most frequent complaint. Of the 40 cases, 33 were submitted to surgery. Of those submitted to surgery, 24 (72.72%) underwent segmental resection, with recurrence in 4 (12.12%) cases. CONCLUSION:Ameloblastoma may relapse when treatment is not performed with broad surgical resection of the lesion with wide safety margins.

Tumores benignos dos maxilares: análise retrospectiva de 10 anos / Benign tumors of the jaws: a 10-year retrospective analysis

OBJETIVO: Avaliar a ocorrência de tumores benignos dos maxilares num período de dez anos. MATERIAL E MÉTODO: A análise retrospectiva envolveu revisão dos prontuários de 108 pacientes, investigando idade, gênero, região anatômica da lesão, tipo de tratamento, além da análise dos espécimes submetidos ao exame histopatológico. RESULTADOS: Dos 108 tumores dos maxilares, 61,0 por cento eram odontogênicos, sendo o Ameloblastoma (20,4 por cento) e o Odontoma (18,5 por cento) os de maior prevalência. A área mais afetada foi a mandíbula com 69,7 por cento. Os tumores não-odontogênicos totalizaram 39,0 por cento dos casos, sendo o Granuloma Central de Células Gigantes (15,0 por cento) e o Fibroma Ossificante (11,1 por cento) os de maior prevalência. A mandíbula foi o sítio mais afetado (81,0 por cento). Para o tratamento cirúrgico dessas neoplasias, foram utilizados os seguintes procedimentos: Curetagem (57,4 por cento), Ressecção Total associada à reconstrução com enxerto autógeno de crista ilíaca (25,9 por cento) e Ressecção Parcial (16,6 por cento). CONCLUSÃO: A maior prevalência foi dos tumores odontogênicos (61,0 por cento). A população afetada foi caracterizada principalmente por mulheres jovens, da segunda e terceira décadas de vida, e a área de maior risco foi a região posterior da mandíbula.

OBJETIVE: The purpose of this study was to evaluate the occurrence of benign tumors of the jaws over a period of ten years. MATERIAL AND METHODS: The retrospective analysis involved a review of the records of 108 patients with these neoplasms, investigating age, sex, anatomic region of the lesion and form of treatment, in addition to an analysis of the specimens submitted to histopathological examination. RESULTS: Of the 108 maxillary tumors, 61.0 percent were odontogenic, the most common ones being ameloblastomas (20.4 percent) and odontomas (18.5 percent). The most affected area was the mandible (69.7 percent). The non-odontogenic tumors accounted for 39.0 of the total, the most common ones being central giant cell granuloma (15.0 percent) and ossifying fibroma (11.1 percent). The mandible was the most affected area (81.0 percent). The surgical treatment of the neoplasms had the following distribution: 57.4 percent curettage; 25.9 percent total resection associated with reconstruction with an autogenous iliac crest bone graft and 16.6 percent partial resection. CONCLUSION: Odontogenic tumors were the most prevalent (61.0 percent). The affected population was characterized mainly by young females, aged 10-29 years, and the area of greatest risk was the posterior mandibular region.

Estudio clínico patológico de odontomas en una muestra de la población brasilera en un período de 15 años / Odontomas clinicopathological study in a sample of the brazilian population over a period of 15 years

Los odontomas son considerados el tipo más común de tumores odontogénicos, generalmente observados en exámenes radiográficos, siendo esa, la base de diagnóstico de muchos estudios. El objetivo del presente tarbajo fue la realización de un análisis retrospectivo descriptivo en el periodo comprendido entre enero de 1992 a enero de 2007 a partir de estudios anatómico-patológicos. Fueron evaluados 238 casos de tumores odontogénicos, de los cuales 44% eran odontomas. Los resultados demostraron que 68,52% de los casos ocurrieron en el género femenino, siendo la 1ª y 2ª décadas de vida las más prevalentes (46,3%). La mayoría de los casos (81,48%) se mostró asintomático, con una discreta predilección por el maxilar (57,41%). El tipo compuesto fue más frecuente que el complejo, con 53,7% y 46,3% de los casos, respectivamente. El presente estudio fue basado en diagnóstico anatomo-patológico, diferenciándose así de estudios ya publicados, que se basan en análisis radiográficos. A pesar de las diferencias entre los estudios sobre género, edad, extensión, localización y síntomas, varias similitudes fueron observadas. Nuevos estudios retrospectivos en diferentes poblaciones son necesarios para promover una mejor comprensión de los odontomas

Odontomas are considered the most common type of odontogenic tumors, usually observed in radiographic examination, which is the basis of diagnosis in many studies. The authors performed a descriptive retrospective analysis in the period from January 1992 to January 2007 from the Pernambuco University Oral Pathology Laboratory's records. Two hundred and thirty eight cases of odontogenic tumors were registered, in which 44% were odontomas. Results showed that 68.52% of the cases were female, with 1st and 2nd decades of life being most prevalent (46.3%). The majority of the cases (81.48%) were asymptomatic, with a discreet predilection to the maxilla (57.41%). The compound type was more frequent than the complex, with 53.7% and 46.3% of the cases, respectively. The present study was based in histological diagnosis, differently from other already published studies, which were based in radiographic analysis. In spite of the differences between the studies in gender, age, extension, location and symptoms, several similarities were observed. New retrospective studies in different populations are necessary in order to provide a better understanding of odontomas

Tumores benignos dos maxilares: análise retrospectiva de 10 anos / Benign tumores of the jaws: retrospective analysis of 10 years

Introdução: Os tumores dos maxilares geralmente são benignos e devem receber considerável atenção quanto ao diagnóstico diferencial e tratamento. Objetivo: Avaliar a ocorrência de tumores benignos dos maxilares num período de dez anos. Forma de Estudo: Retrospectivo. Material e Método: A análise retrospectiva envolveu revisão dos prontuários de 108 pacientes, investigando idade, gênero, região anatômica da lesão, tipo de tratamento, além da análise dos espécimes submetidos ao exame histopatológico. Resultados: Dos 108 tumores dos maxilares, 61,0% eram odontogênicos, sendo o Ameloblastoma (20,4%) e o Odontoma (18,5%) os de maior prevalência. A área mais afetada foi a mandíbula com 69,7%. Os tumores não-odontogênicos totalizaram 39,0% dos casos, sendo o Granuloma Central de Células Gigantes (15,0%) e o Fibroma Ossificante (11,1%) os de maior prevalência. A mandíbula foi o sítio mais afetado (81,0%). Para o tratamento cirúrgico dessas neoplasias, foram utilizados os seguintes procedimentos: Curetagem (57,4%), Ressecção Total associada à reconstrução com enxerto autógeno de crista ilíaca (25,9%) e Ressecção Parcial (16,6%). Conclusão: A maior prevalência foi dos tumores odontogênicos (61,0%). A população afetada foi caracterizada, principalmente, por mulheres jovens, da segunda e terceira décadas de vida, e a área de maior risco foi a região posterior da mandíbula.

Introduction: The majority of maxillary tumors is benign and has received considerable attention in the differential diagnosis and treatment. Aim: The objective of this research was to evaluate the occurrence of benign tumors of the jaws in the period of ten years. Study design: Retrospective. Material and methods: The retrospective analysis involved revision of the promptuares of 108 patiens with these neoplasms, investigating age, sex, anatomic region of the lesion, treatment type, besides the analysis of the specimens submitted to histopathological exam. Results: Between the odontogenic tumors (61,0%), the most commons were Ameloblastoma (20,4%) and Odontome (18,5%). The most affected area was the mandible (69,7%). The non-odontogenic tumors (39,0%), the most commons were Central Giantic Cell Granuloma (15,0%) and Ossifying Fibroma (11,1%). The mandible was the most affected area (81,0%). The surgical treatment of those neoplasms had the following distribution: 57,4% Curetage; 25,9% Total Resection associated the reconstruction with autogenous iliac crest bone graft and 16,6% Partial Resection. Conclusion: The largest occurrence was of the odontogenic tumors (61,0%). The affected population was characterized mainly by young women, of second and third decades of life, and the area of larger risk was the posterior mandible region.

Tratamento de ameloblastoma: [revisão] / Treatment of ameloblastoma: [review]

O ameloblastoma é um tumor odontogênico da maxila e da mandíbula, sendo indolor; é benigno e incide mais em mandíbula. São lesões localizadas e tumores odontogênicos agressivos. Apresenta alto índice de recidiva. O cirurgião dentista tem um papel importante no diagnóstico dessas lesões por meio do uso da radiografia panorâmica, que é importante instrumento no diagnóstico diferencial. O aspecto radiográfico de favos de mel ou de bolhas de sabão é o principal indício de sua presença. A presença de reabsorções e deslocamentos dentários deve ser considerada também. O ameloblastoma unicístico pode ser confundido clinica e radiograficamente com cisto dentígero e este ocorre em jovens e, entre a segunda e terceira década de vida. Inúmeras alternativas de tratamento têm sido propostas na literatura e, destas, as técnicas de ressecção demonstram melhores resultados em relação ao índice de recidiva e sobrevida do paciente.

Ameloblastoma is a painless odontogenic tumor of the jaws. It is benign and occurs more often in the mandible. They are localized and aggressive lesions. Clinicians have an important role in the diagnosis of such lesions, through the use of the panoramic X-rays, which is an important tool for their the differential diagnosis. The radiographic aspect of honey combs or soap bubbles under the panoramic X-rays is the main indication of its presence. The presence of reabsorption and dental displacement areas should also be considered in the differential diagnosis. The unicystic ameloblastoma can be misleading with dentigerous cyst, and it happens in youngsters, between second and third decade of life. Several treatment approaches have been proposed in the literature, and of those, the resective techniques described have been demonstrating better results in relation to the recurrence of the lesion and for the long-term results.

Tumor odontogênico adenomatóide extrafolicular: uma apresentação infreqüente de um tumor raro / Extrafollicular adenomatoid odontogenic tumor: an unusual presentation of a rare tumor

O tumor odontogênico adenomatóide (TOA) é uma lesão benigna, não invasiva e de crescimento lento e progressivo. Existem três variantes clínicas, denominadas folicular, extrafolicular e periférica. Relatamos um caso de paciente do gênero feminino, com 35 anos, com TOA variante extrafolicular, localizado em maxila. Exames diagnósticos de imagem revelaram tumor localmente agressivo, com destruição óssea, sem invasão de tecidos adjacentes. A paciente foi tratada com enucleação cirúrgica conservadora. Encontra-se sem evidência de doença, após seguimento de cinco meses.

The adenomatoid odontogenic tumor (AOT) is a benign, non-invasive and low growth tumor. There are three clinical variants: follicular, extrafollicular and periferical. We report a case of a woman, 35 years-old with extrafollicular AOT, located in maxilla. Diagnostic image exams revealed locally aggressive tumor with bone destruction, without adjacent tissues invasion. The patient was treated with surgical enucleation. Nowadays, she has been with no evidence of disease after five-month follow-up.

Lesões fibro-ósseas benignas dos maxilares: estudo epidemiológico de 112 casos / Benign fibro-osseous lesions of the jaws: epidemiological study of 112 cases

Introdução: O grupo de lesões fibro-ósseas incluem os hamartomas, processos displásicos e reativos, bem como neoplasmas, possuindo como aspecto comum a substituição do osso por tecido conjuntivo fibroso e contendo quantidades variáveis de tecido mineralizado. Pacientes e Método: Foi realizado um estudo retrospectivo no período de julho de 1992 a julho de 2007 no arquivo de prontuários dos pacientes diagnosticados no Laboratório de Patologia Bucal da Faculdade de Odontologia da Universidade de Pernambuco - FOP/UPE. Foram analisados os indicadores gênero, faixa etária, presença de sintomatologia, localização topográfica e tipo histopatológico. Resultados: Do total de 112 casos, 54 casos eram fibroma cemento-ossificante, 41 casos de lesões fibro-ósseas e 17 casos de displasia fibrosa. As segunda e terceira décadas de vida foram as de maior ocorrência (56 casos), 70 casos na mandíbula e, em sua maioria, mostraram-se assintomáticos (87 casos). A raça caucasiana foi a mais acometida (55 casos), bem como o gênero feminino (78 casos).

Introduction: The fibro-osseous lesions include hamartomas, dysplastic and reactive processes and neoplasms. They present a common pattern by replacement of bone to fibrous osseous tissue with variable amount of mineralized tissue. Patients and methods: A retrospective study was performed from July 1992 to July 2007 in the patients charts of Laboratório de Patologia Bucal, School of Odontology, Universidade de Pernambuco - FOP/UPE. Gender, age, symptoms, topographic site, and histological type were analyzed. Results: Out of 112 cases, 54 cases were cemento ossifying fibroma, 41 cases were fibro-osseous lesions, and 17 cases were fibrous dysplasia. The second and third decades of life presented higher incidence (56 cases), 70 cases occurred in the mandible and the majority were asymptomatic (87 cases). The Caucasians were more prevalent (55 cases), as well as the feminine gender (78 cases).

A Case of Melanotic Neuroectodermal Tumor of Infancy / 대한이비인후과학회지

The melanotic neuroectodermal tumor of infancy (MNTI) is a rare osteolytic pigmented neoplasm that most frequently arises from the anterior maxillary alveolar ridge. It presents in the first few months of life, and usually follows a benign course. We present a 5-month-old girl with a melanotic neuroectodermal tumor of infancy of maxilla.