Desordens hiperostóticas em American Bully / Hiperostotic disorders in american bully

O complexo de desordens hiperostóticas é uma condição rara e autolimitante, que tem as mesmas características histopatológicas, que cursa com proliferação óssea de caráter não neoplásico. Acomete cães jovens de raças distintas, com variabilidade quanto ao tipo de proliferação óssea e quanto aos ossos acometidos. O complexo é composto pela osteopatia craniomandibular, hiperostose da calota craniana e osteodistrofia hipertrófica. Podendo estar presente nos ossos da calota craniana, mandíbulas, coluna cervical e esqueleto apendicular. O presente relato, descreveu o quadro de uma cadela, da raça American Bully, não castrada, três meses de idade, que foi atendida com queixa de aumento de volume doloroso das mandíbulas, hiporexia e sialorreia há 15 dias, apresentando ao exame físico, amplitude de movimento diminuída e sensibilidade dolorosa da articulação temporomandibular, espessamento firme bilateral do crânio em região de fossa temporal, espessamento palpável de consistência firme das mandíbulas e crepitação respiratória. Após avaliação clínica e realização de exames complementares, chegou-se ao diagnóstico presuntivo, de complexo de desordens hiperostóticas. Foi instituído como conduta terapêutica o suporte analgésico, sendo eficaz para a manutenção das necessidades fisiológicas até a paciente alcançar a fase adulta. O prognóstico para esta paciente foi considerado bom, uma vez que não havia indícios de anquilose da articulação temporomandibular e/ou manifestações neurológicas.

The complex of hyperostotic disorders is a rare and self-limiting condition, which has the same histophatological characteristics, which courses with non-neoplastic bone proliferations. It affects young dogs of different breeds, with variability the bones affected. The complex is composed of craniomandibular osteopathy, calvarial hyperostotic syndrome and hypertrophic osteodystrophy. It may be present in the bones of the skullcap, jaws, cervical spine and appendicular skeleton. The present report describes the condition of a female dog, American Bully breed, entire, three months old, with a complaint of painful swelling of the jaws, hyporexia and drooling for 15 days, presenting on physical examination, reduced amplitude and pain of the temporomandibular joint, bilateral firm thickening of the skull in the temporal fossa region, palpable firm-consistent thickening of the mandibles and respiratory crackle. After clinical evaluation and complementary tests, a presumptive diagnosis of hyperostotic disorders complex was reached. It was instituted pain management as a treatment, being effective for the maintenance of physiological needs until the patient reaches the adulthood. The prognosis for this patient was considered good, since there was no evidence of temporomandibular joint ankylosis and/or neurological manifestations.

Protocolo de aplicação bilateral de toxina botulínica tipo A para evitar assimetria no tratamento de espasmo hemifacial / Protocol for bilateral application of botulinum toxin type A to avoid asymmetry during treatment of hemifacial spasms

Introdução: O espasmo hemifacial (EHF) caracteriza-se por movimento tônico-clônico involuntário da musculatura de uma hemiface. O tratamento tem sido realizado com aplicação de toxina botulínica (TxB). A aplicação unilateral classicamente descrita resulta em assimetria semelhante à paralisia facial. O objetivo desse trabalho foi normatizar o tratamento do EHF bilateralmente com TxB, a fim de prevenir a ocorrência de assimetria facial iatrogênica. Método: Foram analisadas 66 aplicações em 15 pacientes, seguindo o protocolo do serviço para paralisia facial, acrescentado de pontos pré-tarsais no lado com EHF. Foi feita dose complementar na reavaliação após 15 dias nos pacientes que apresentavam algum grau residual de espasmo ou assimetria, buscando-se a dose necessária para alcançar controle satisfatório do espasmo sem causar assimetria facial. Resultados: A dose média total foi 20,2 U do lado não acometido e 28,4 U do lado acometido, totalizando 48,6 U por aplicação. Houve diferença significante entre as hemifaces na dose para os músculos zigomático, orbicular da boca e orbicular dos olhos. Conclusões: A técnica proposta de aplicação bilateral de TxB controlou adequadamente o EHF e evitou assimetria iatrogênica. Como regra geral, a aplicação deve ser feita na proporção de 1:1,5 U no orbicular dos olhos (porção lateral) e 1:2 U no orbicular da boca. Nos demais músculos, a dose nos dois lados deve ser a mesma, realizando-se dose de reforço em 15 dias caso permaneça algum grau de espasmo. O único local com pontos exclusivos do lado acometido é a região pré-tarsal do músculo orbicular do olho.

Introduction: Hemifacial spasm (HFS) is characterized by the involuntary tonic-clonic movement of the muscles of the hemiface. It is usually treated with botulinum toxin (BTX). The classically described unilateral application of BTX results in an asymmetry similar to facial paralysis. The aim of this study was to standardize the treatment of HFS by applying BTX bilaterally to prevent the occurrence of iatrogenic facial asymmetry. Methods: The outcomes of 66 applications in 15 patients were analyzed according to the protocol of the facial paralysis service, to which pretarsal sites were added on the HFS side. On reassessment 15 days later, a complementary dose was administered to patients who exhibited some residual degree of spasm or asymmetry with the aim of determining the dose required to achieve satisfactory spasm control without causing facial asymmetry. Results: The total mean dose was 20.2 U at the contralateral side and 28.4 U at the spasm side (a total dose of 48.6 U per application). There was a significant difference between the doses applied to the zygomaticus, orbicularis oris, and orbicular oculi muscles on each hemiface . Conclusions: The proposed bilateral BTX application technique was effective in controlling HFS and prevented iatrogenic asymmetry. In general, application should be performed at a ratio of 1:1.5 U in the orbicularis oculi (lateral portion) and 1:2 U in the orbicularis oris. In the remaining muscles, the same dose should be administered on both sides and an additional dose can be applied 15 days later if some degree of spasm is present. The pretarsal region of the orbicularis oculi muscle is the only area for which BTX application on the healthy side is unnecessary.

Alterações do sistema miofuncional orofacial na síndrome de Parry-Romberg: revisão crítica da literatura / Alterations of the myofunctional orofacial system in the Parry-Romberg syndrome: a critical literature review

INTRODUÇÃO Esta revisão qualitativa da literatura analisou publicações científicas internacionais sobre possíveis alterações miofuncionais orofaciais em pacientes acometidos pela Síndrome de Parry-Romberg, por meio da base de dados PubMed. MÉTODOS: O levantamento realizado limitou-se a seres humanos, de qualquer faixa etária, no idioma inglês, entre os anos 2002 e 2012. As publicações sem acesso completo, repetidas por sobreposição das palavras-chave, revisões de literatura, cartas ao editor e as não relacionadas diretamente ao tema foram excluídas. RESULTADOS: Foram identificados 719 estudos, sendo 21 dentro dos critérios estabelecidos. Com base nos estudos selecionados, pacientes acometidos pela Síndrome de Parry-Romberg podem apresentar alterações dos tecidos mole e duro, tais como atrofia dos músculos esternocleidomastoideo, masseter e pterigoideos; atrofia na região da bochecha e depressão da prega nasolabial; desvio dos lábios e nariz; atrofia unilateral da língua; atrofia do ângulo da boca; reabsorção progressiva do osso da maxila e da mandíbula; atrofia do arco zigomático, do osso frontal e assimetria facial; desenvolvimento atrófico das raízes ou reabsorção patológica dos números de dentes permanentes; redução da mandíbula e erupção atrasada dos dentes superiores e inferiores. CONCLUSÃO: Apesar do crescente interesse pelo diagnóstico e pela descrição sintomatológica de indivíduos com Síndrome de Parry-Romberg, a escassez de publicações que abordem tratamentos funcionais e interdisciplinares é evidente. Verifica-se a necessidade da realização de estudos mais específicos que visem à melhoria da qualidade de vida desses pacientes.

INTRODUCTION This qualitative literature review analyzed international scientific publications on possible orofacial myofunctional alterations in patients with Parry-Romberg syndrome by using PubMed. METHODS: The survey was conducted in English, between 2002 and 2012, and was limited to human beings of any age. Publications without full access, duplicated by overlapping keywords, literature reviews, letters to the editor, and those not directly related to the research topic were excluded. RESULTS: We identified 719 studies, of which 21 were within the established criteria. Based on the selected studies, patients with Parry-Romberg syndrome may show changes in soft and hard tissues such as atrophy of the sternocleidomastoid, masseter, and pterygoid muscles; atrophy in the cheek region and depression of the nasolabial fold; deviation of the lips and nose; unilateral tongue atrophy; atrophy of the mouth angle; progressive resorption of the maxilla and mandible bone; atrophy of the zygomatic arch and frontal bone, and facial asymmetry; atrophic root development or pathological resorption of permanent tooth numbers; and jaw reduction and delayed eruption of the upper and lower teeth. CONCLUSION: Despite the growing interest in the diagnosis and symptomatic description of individuals with Parry-Romberg syndrome, publications that address functional and interdisciplinary treatments are scarce. Therefore, specific studies aimed at improving the quality of life of these patients are needed.

The use of three-dimensional cephalometric references in dentoskeletal symmetry diagnosis

OBJECTIVE: The aim of this study is to assess dentoskeletal symmetry in cone-beam computed tomography (CBCT) scans of Brazilian individuals with Angle Class I malocclusion. MATERIAL: A total of 47 patients (22 females and 25 males) aged between 11 and 16 years old (14 years) seen in a private radiology service (CIRO, Goiânia, GO, Brazil) were assessed. All CBCT scans were obtained from January, 2009 to December, 2010. Cephalometric measurements were taken by multiplanar reconstruction (axial, coronal and sagittal) using Vista Dent3DPro 2.0 (Dentsply GAC, New York, USA). Minimum, maximum, mean and standard deviation values were arranged in tables, and Student t-test was used to determine statistical significance (P < 0.05). RESULTS: Data were homogeneous, and differences between the right and left sides were not significant. CONCLUSIONS: Cephalometric measurements of Brazilian individuals with Angle Class I malocclusion can be used to establish facial symmetry and three-dimensional standard references which might be useful for orthodontic and surgical planning. .

OBJETIVO: o objetivo deste estudo é avaliar a simetria dentoesqueléticas em imagens de tomografia computadorizada de feixe cônico (TCFC) de indivíduos brasileiros com má oclusão Classe I de Angle. MÉTODOS: quarenta e sete pacientes (22 meninas e 25 meninos), com idades entre 11 e 16 anos (14 anos, em média), foram atendidos em um serviço de radiologia privado. Todas as imagens de TCFC foram adquiridas a partir de janeiro de 2009 a dezembro de 2010. Medições cefalométricas foram realizadas por reconstruções multiplanares (axial, coronal e sagital) usando o VistaDent 3D Pro 2.0 ( Dentsply GAC, Nova Iorque, EUA). O desvio-padrão mínimo, máximo e a média foram descritos em tabelas, e o teste t de Student foi utilizado para definir significância estatística (p < 0,05). RESULTADOS: os dados foram homogêneos e as diferenças entre os lados direito e esquerdo não foram significativas. CONCLUSÕES: as medidas cefalométricas de indivíduos brasileiros com má oclusão Classe I de Angle podem ser usadas para definir a simetria facial e referências de padrão tridimensional, que podem ser úteis para o planejamento ortodôntico e cirúrgico. .

Evaluation of craniofacial morphology in patients with obstructive sleep apnea using lateral cephalometry and dynamic MRI.

Context: Obstructive sleep apnea (OSA) is a potentially life-threatening disorder, characterized by repeated collapse of the upper airway during sleep with cessation of breathing. The altered mouth breathing produces morphological changes in craniofacial region. Aim: This study was designed to compare and validate the craniofacial morphological characteristics in patients with OSA using lateral cephalometry and to investigate the dentofacial characteristics of patients with OSA with respect to the obstructive sites determined by dynamic magnetic resonance imaging (MRI) to more accurately clarify the pathophysiological features. Materials and Methods: 10 patients with OSA were divided into two groups of five each according to their obstructive site determined by dynamic MRI. (1) Obstruction at the retropalatal and retroglossal region (Rp + Rg group) and (2) obstruction at the retropalatal region (Rp group). Lateral cephalogram both in upright and supine position was taken for all the subjects. In addition, dynamic MRI was performed to identify the sites of obstruction of the upper airway. Statistical analysis used: Independent t-test was performed to evaluate the significant difference in the upright cephalometric variables between the study and control group and between the two groups. The changes in skeletal and soft tissue parameters with change in posture was assessed within the study and control group by paired t test. P value of ≤0.05 was considered as statistically significant. Results: The study indicated that the first group of patients with both retropalatal and retroglossal obstruction showed signs of skeletal discrepancy that predisposed to obstruction at the retroglossal level and the soft tissue components like the soft palate and tongue that contributed to retropalatal obstruction. However, the second group of patients with only retropalatal obstruction had primarily soft tissue components associated with increased BMI that contributed to retropalatal obstruction. Conclusion: Evaluation of craniofacial morphology in OSA patients is bound to help the concerned specialist in recognizing the morphological changes induced by altered sleep pattern so as to provide the appropriate treatment.

Skeletal alterations associated with the use of bonded rapid maxillary expansion appliance

Bonded maxillary expansion appliances have been suggested to control increases in the vertical dimension of the face after rapid maxillary expansion (RME). However, there is still no consensus in the literature about its real skeletal effects. The purpose of this prospective study was to evaluate, longitudinally, the vertical and sagittal cephalometric alterations after RME performed with bonded maxillary expansion appliance. The sample consisted of 26 children, with a mean age of 8.7 years (range: 6.9-10.9 years), with posterior skeletal crossbite and indication for RME. After maxillary expansion, the bonded appliance was used as a fixed retention for 3.4 months, being replaced by a removable retention subsequently. The cephalometric study was performed onto lateral radiographs, taken before treatment was started, and again 6.3 months after removing the bonded appliance. Intra-group comparison was made using paired t test. The results showed that there were no significant sagittal skeletal changes at the end of treatment. There was a small vertical skeletal increase in five of the eleven evaluated cephalometric measures. The maxilla displaced downward, but it did not modify the facial growth patterns or the direction of the mandible growth. Under the specific conditions of this research, it may be concluded that RME with acrylic bonded maxillary expansion appliance did promote signifciant vertical or sagittal cephalometric alterations. The vertical changes found with the use of the bonded appliance were small and probably transitory, similar to those occurred with the use of banded expansion appliances.

Os aparelhos disjuntores com cobertura oclusal de acrílico têm sido sugeridos para controlar o aumento da dimensão vertical da face após a expansão rápida da maxila (ERM). Entretanto, ainda não há consenso na literatura sobre seu real efeito esquelético. O objetivo desse estudo prospectivo foi avaliar longitudinalmente as alterações esqueléticas verticais e sagitais após a ERM realizada com o aparelho disjuntor com cobertura oclusal. A amostra consistiu de 26 crianças, com idade média de 8,7 anos (variação: 6.9-10,9 anos), apresentando mordida cruzada posterior esquelética e indicação para ERM. Após a expansão maxilar, o aparelho foi utilizado como contenção fixa por 3,4 meses, sendo posteriormente substituído por uma contenção removível. O estudo cefalométrico foi realizado em telerradiografias laterais tomadas antes do início do tratamento e novamente 6,3 meses após a remoção do disjuntor. A comparação intragrupo foi feita utilizando-se o teste t pareado. Os resultados mostraram que não houve alterações esqueléticas sagitais significantes ao fim do tratamento. Houve um pequeno aumento em cinco das onze medidas cefalométricas verticais analisadas. A maxila se moveu inferiormente, porém não modificou o padrão de crescimento facial, a inclinação ou direção de crescimento mandibular. Considerando-se as condições específicas deste trabalho, pode-se concluir que a ERM realizada com o aparelho disjuntor com cobertura oclusal de acrílico não promoveu alterações esqueléticas verticais ou sagitais prejudiciais. As alterações verticais encontradas com o uso do aparelho colado foram pequenas e provavelmente transitórias, similar ao que ocorre com o uso dos aparelhos expansores bandados.

Clinical, microscopic and imaging findings associated to Mccune-Albright syndrome: report of two cases

McCune-Albright syndrome is characterized by the triad café-au-lait cutaneous spots, polyostotic fibrous dysplasia and endocrinopathies. This article presents two cases of McCune-Albright syndrome in a middle-aged woman and a young girl. Both patients presented café-au-lait spots on the face and other parts of the body and expansion of the mandible with radiopaque-radiolucent areas with ground-glass radiographic appearance, and were diagnosed as having fibrous dysplasia and endocrine disorders. The patient of Case 1 had fibrous dysplasia on the upper and lower limbs, thorax, face and cranium, early puberty, hyperglycemia, hyperthyroidism and high serum alkaline phosphatase levels. The patient of Case 2 presented lesions on the upper limbs and evident endocrine disorders. In both cases presented in this article, the initial exam was made because of the mandibular lesion. However, a diagnosis of fibrous dysplasia must lead to investigation of the involvement of other bones, characterizing polyostotic fibrous dysplasia, which is manifested in a number of diseases. An accurate differential diagnosis is mandatory to determine the best treatment approach for each case.

A Síndrome de McCune-Albright é caracterizada pela tríade manchas café-com-leite na pele, displasia fibrosa poliostótica e endocrinopatias. Este artigo apresenta dois casos de Síndrome de McCune-Albright em uma mulher de meia idade e em uma menina. Ambos apresentavam manchas café-com-leite na face e em outras partes do corpo, expansão da mandíbula com área radiopaca-radiolúcida com aspecto de vidro despolido na radiografia, com o diagnóstico de displasia fibrosa, e desordens endócrinas. O paciente do Caso 1 apresentava displasia fibrosa nos membros inferiores e superiores, tórax, face e crânio, puberdade precoce, hiperglicemia, hipertireoidismo e elevação da fosfatase alcalina no sangue. O paciente do Caso 2 apresentava lesões nos membros superiores e desordem endócrina evidente. Em ambos os casos apresentados neste artigo, o exame inicial foi realizado devido à lesão mandibular. Contudo, o diagnóstico de displasia fibrosa deve conduzir a pesquisa de envolvimento de outros ossos, caracterizando a displasia fibrosa poliostótica, que se manifesta em um grande número de doenças. O diagnóstico diferencial preciso é fundamental para determinar o tratamento adequado a cada caso.

Maxillary hyperplasia and hyperostosis cranialis. A rare manifestation of renal osteodystrophy in a patient with hyperparathyroidism secondary to chronic renal failure

This case report describes a 21-year-old female patient with a complex medical condition of end-stage chronic renal failure and secondary hyperparathyroidism presenting with a history of gradual enlargement of the facial bones over a period of one year. The facial enlargement primarily involves the maxilla causing a bizarre facial and dental deformity. Based on the clinical, radiographic, and laboratory investigations the facial deformity was confirmed as a rare manifestation of renal osteodystrophy presenting as maxillary hyperplasia and hyperostosis cranialis

Dental findings in GAPO syndrome: case report

This article reports the case of a young female adult with GAPO syndrome who presented as a peculiar dental finding unerupted primary and permanent dentitions, which resembled total anodontia on clinical examination. A cephalometric analysis was performed to investigate the alterations in facial bone development. This is the 9th GAPO syndrome case reported in a Brazilian patient.

Este artigo relata o caso de um jovem paciente, gênero feminino, portadora da síndrome de GAPO, apresentando impacções dos dentes decíduos e permanentes, sugerindo anodontia total no exame clínico. Foi realizada uma análise cefalométrica para investigar as alterações no desenvolvimento ósseo facial. Este é o nono caso descrito no Brasil

Cephalometric craniofacial characteristics of a sample of Saudi female adults with class III malocclusion

The purpose of this study was to investigate the morphologic characteristic of the craniofacial complex of Saudi adult females with Class III malocclusion. Lateral cephalometric radiographs of 30 Saudi adult females with Class III malocclusion [ages 18 to 28 years] were selected from the pretreatment orthodontic files of College of Dentistry of King Saud University. Cases were analyzed and compared with a Class III control group that was matched for age and sex. The Saudi females with Class Ill malocclusion exhibited a distinct craniofacial morphologic characteristic that was manifested in a combination of alterations in angular and linear measurements on the lateral cephalogram. The anterior [S-N], posterior [S-Ar] and total cranial base [S-Ar] linear measurements were significantly shorter, and the cranial base angle [N-S-Ar and N-S-Ba] was significantly smaller in Class III than in control. Maxillary length [ANS-PNS] was significantly smaller, and the maxilla was more posteriorly positioned in the patients with Class III malocclusion. The mandible and chin position were prognathic, and there was increase in total mandibular length [Ar-Pog] accompanied by obtuse gonial [Ar-Go-Me] angle and steeper mandibular plane. Both the ramal height [Ar-Go] and the posterior facial height were significantly shorter in Class III malocclusion than in control. Dental compensation in the patients with Class III was manifested by protrusion of the maxillary incisors and retrusion of mandibular incisors. There was tendency to open bite in these Class III malocclusions. The soft tissue reflects the underlying skeletal pattern by retrusion of upper and lower lips to esthetic line, and smaller nasiolabial angle

Cephalometric Evaluation using Mcnamara analysis in a sample of Saudi adults

The purpose of this study was to describe cephalometric norms of Saudi adults using McNamara's analysis and to compare with the result obtained by McNamara. Cephalometric radiographs of 95 adults 45 males and 50 females, the mean ages were 28.4 years for males and 25.3 for females. All samples fulfilled the criteria of selection. Twelve points were digitized and processed by Dentofacial Planner R computer software program. Ten measurements, 8 linear and 2 angular were identified. For statistical evaluation, one sample t-test was performed. The mean values and the standard deviations for the cephalometric variables were obtained and the means were compared with McNamara study. Both Saudi males and females, have long lower anterior facial height, increased mandibular plane angle, and posterior positioned of the chin. The Saudi females have slightly increased mandibular length, slight prominence of midfacial length and maxillo-mandibular differential fall towards higher values. Dentally Saudi males showed protruded upper and lower incisors whereas the Saudi females showed protrusion in the lower incisors

cephalometric study to identify classification of malocclusion in patients attending orthodontic unit of the dental section at CH and ICH Lahore

This study was conducted to identify different classifications of malocclusion in patients attending orthodontic unit of dental section at the Children's Hospital and the Institute of Child Health Lahore. This analytical, cross sectional study included 50 patients [25 boys and 25 girls]. Age of these patients ranged from 9 to 14 years with a mean of 11.5 years, SD +/- 1.84. The age range for the boys was from 9 to 14 years having a mean of 11.4 years, where as in girls the age ranged from 9 to 14 years with a mean of 11.1 years. Lateral cephalometric radiographs were used for the analysis. A comprehensive cephalometric analysis was made on tracing sheets using multiple reference planes and 28 linear and angular measurements. Paired t- test was applied for the significant difference between the mean values. The results showed that 23 patients, 11 male and 12 female presented with skeletal class I malocclusion where as 26 patients, 14 male and 12 female were found to have Skeletal class II malocclusion only one patient presented with skeletal class III malocclusion. Dental analysis of the whole sample size was found to have 18 patients with dental class 2 div I malocclusion, 12 patients with bimaxillary proclination, lI patients with normal class 1 occlusal relationship, 7 with dental class 2 div II malocclusion and the remaining 2 were seen with dental class 3 occlusal relationships. Statistically significant differences were found with p<0.05. The study concluded that certain measurements used for cephalometric analysis did not correlate with this study sample

Estudo histopatológico da estrutura óssea da bolha etmoidal em rinossinusite crônica / The histopathological study of the bone structure of etmoidal bulla in chronic rhinosinusitis

Estudos têm demonstrado alterações histopatológicas que ocorrem em rinossinusite crônica. O objetivo é descrever as características histopatológicas da estrutura óssea da bolha etmoidal. Por meio da microscopia de luz, foram analisadas as trabéculas ósseas e também a lâmina própria À microscopia de luz, a análise das trabéculas ósseas mostrou que a aposição óssea de 19 pacientes. À microscopia eletrônica foi analisada a morfologia óssea. estava presente em todos os casos; osteóide, osteoblastos e fibrose em quase todos; reabsorção e remodelação óssea em menos da metade; osteoclastos não foram encontrados / Studies have shown histopathological alterations which occur in chronical rhinosinusitis . The aim of this study is to describe these histopathological caracteristics of the bone structure of the ethmoidal bulla. Through light microscope, the bone trabeculae of etmoidal bulla and lamina propria of 19 patients was analysed. The bone morphology was analysed using eletronic microscopy . Through light microscope the analysis of the bone trabeculae showed that bone apposition was present in all cases, osteoids, osteoblasts and fibrosis in almost all; reabsorption and bone remodeling in less than half the cases, osteoclasts were not found...

Comprometiendo la estructura osteo-facial de las poblaciones humanas del Antiguo Perú por la Leishmaniasis Tegumentaria de forma mucosa / Commiting the oste-facial structure of the human populations from the old Perú for the leishmaniasis diffuse cutaneous

Desde 1900 a 1995, cuatro fueron las razones que justificaban la defensa de la antigüedad de Leishmaniasis Tegumentaria Americana (LTA) en el Perú: 1) la existencia de ciertas piezas de cerámica antropomórfica Mochica, o huacos, con mutilaciones principalmente de los labios superiores y de la nariz; 2) las breves referencias proporcionads por algunos cronistas de la época de la conquista y del primer período de la colonia; 3) la existencia de determinados términos quechuas, que indicaríam ideas asimilables a la de la uta; y 4) el área de distribución epidemiológica actual bien definida y fija através del tiempo. Sin embargo, todas eran evidencias debiles e indirectas, y sin contexto arqueológico. Objetiva la búsqueda de material humano paleopatológico, que al mismo tiempo constituya evidencia directa que pueda contribuir para la solución definitiva de esa cuestión que ya dura aproximadamente un siglo. La evidencia paleopatólogica de alteración mucoso deformante en poblaciones humanas del antiguo Perú sugiere la presencia de LTA en una posible población agrícola que vivió próximo al área actualmente endémico de leishmaniasis, entre los siglos XIV-XVI. Las ppoblaciones oriundas del Perú que habitan determinadas regiones de esta endemia "aparentemente" no son afectadas por esta patología, probablemente por la antigüedad de la misma en esa región. La metodología es concerniente a la anatomia patológica, pasando por 2 etapas: primero fue definir el patrón patológico de LTA de forma mucosa en el cráneo humano, seleccionando pacientes en tratamiento del Centro de Pesquisa Hospital Evandro Chagas (FIOCRUZ), Rio de Janeiro, con historia clínica y destrucción del macizo facial, principalmente la cavidad oro-nasal. Segundo, la búsqueda de un material arqueológico que se prestase a esta comparación. Así, revisamos 241 cráneos procedente del cementerio Inca de Makat-tampu, valle de Rímac, Lima, Perú. La tasa de 2,07 por dento de lesione mucosas compatibles con LTA puede sugerir que la prevalencia era alta en tiempos prehisplánicos y confirman la hipótesis y los antecedentes indirectos. Este estudio paleopatológico tiene por base el enfoque biocultural que permitió aproximarnos a la reconstrucción histórica de la vida cotidiana de los hombres agrícolas del valle de Rimac, durante la ocupación Incaica entre los siglos XIV y XVI después de Cristo.

Bone changes in leprosy patients with disabilities/deformities (a clinico-radiological correlation).

One hundred and ten leprosy patients (96 males and 14 females, mean age 45.3 years) with disabilities/deformities were examined radiologically to evaluate bone changes and correlating them with clinical parameters. Most patients (98) had paucibacillary leprosy. The mean duration of leprosy was 7.4 years and that of deformity was 4.1 years. Ten patients presented with reaction. Seventy-five (68.2%) patients had received a full course of antileprosy treatment. The overall prevalence of bone changes was 87.3% (96 patients); specific, non-specific, osteoporotic and facial changes were seen in 44.5%, 75.5%, 38.2% and 9.1% of the patients respectively. Among the specific bone changes, primary periosteitis (28.2%) and "bone cysts" (22.7%) were the more common findings. Among the non-specific bone changes, terminal phalangeal absorption (48.2%), soft tissue changes (44.5%) and concentric absorption (32.7%) were more common. Specific bone changes showed a significant (P < 0.05) increase with lack of or incomplete antileprosy treatment. Non-specific bone changes showed significant correlation (P < 0.05) with increasing duration of disease, lack of or partial treatment and rising disability index. Osteoporotic changes showed a significant relationship with rising disability index.

Osteosarcoma del macizo craneofacial: experiencia en el Instituto de Oncología Luis Razetti, Caracas / Osteosarcoma of solid craniofacial: experience in the Institute of Incology Luis Razetti, Caracas

El Sarcoma Osteogénico es el tumor primario maligno más frecuente del hueso y relativamente raro en la región cráneo facial. el osteosarcoma de cráneo representa el 1.6 por ciento y los de maxilar y mandibula el 6,5 por ciento . Puede ser primario o secundario a Enfermedad de Paget o a Radioterapia. El síntoma y signo predominante es el aumento de vólumen, doloroso o no, del área afectada. El promedio de edad es de 38 años y sólo el 16 por ciento de los pacientes son menores de 13 años. No hay imagen radiológica característica. El pronóstico es desfavorable obteniéndose la mayor sobrevida en los pacientes con Osteosarcoma de mandíbula. En el IOLR en las ultimas 3 décadas, se han registrado 14 pacientes, con el Diagnóstico de Osteosarcoma localizado en el macizo craneofacial, de los cuales 9 son presentados en esta revisión. El promedio de edad fue de 20,6 años, 6 pacientes de sexo femenino y 3 del masculino. el síntoma predominante fue el aumento de volumen no doloroso en el área afectada, 8 pacientes consultaron previamente a odontólogo, 8 pacientes con tumor primario y 1 secundario a radioterapia por Retinoblastoma en ojo derecho. El tratamiento inicial en 3 pacientes fue radioterapia, en uno conjuntamente con quimioterapia. Dos de estos casos (Qt + Rt, y sola) fueron seguidos de cirugía y uno por Qt. En 2 pacientes el tratamiento primario fue cirugía seguido de radioterapia, luego quimioterapia en ambos casos. En 1 caso fue cirugía y otro fue tratado. un caso recibió 1 xiclo de quimioterapia sin control sucesivo. De los 9 pacientes, 2 con tumor en mandíbula tuvieron sobrevida libre de enfermedad hasta su último control a los 7 años y 5 murieron el primer año. El paciente con el osteosarcoma post radiación sobrevivió 2 años con enfermedad y actualmente existe otro paciente en tratamiento con quimioterapia neoadyuvante a quien ya se le realizó cirugía. en conclusión, el osteosarcoma del maciso craneofacial es un tumor sumamente raro asociado a una alta mortalidad independientemente de la terapéutica aplicada

Tumores óseos craneofaciales: frecuencia y respuesta al tratamiento / Craniofacial bone tumours: frecuency and treatment resonse

En el periodo comprendido entre enero de 1985 y diciembre de 1989, se atendieron en el Servicio de Oncología del Hospital General de México, 112 pacientes con lesiones óseas de localización craneofacial de los cuales 76 (67.9 por ciento), correspondieron a lesiones malignas, de éstas 10 (8.9 por ciento, fueron primarias y 67 (59.8 por ciento) secundarias, los restantes 36 casos (32.1 por ciento) correspondieron a lesiones benignas. El promedio de edad para las lesiones malignas fue de 58.4 años y para las benignas fue de 32.7 años (p = 0.00000006) de las 76 neoplasias malignas 49 correspondieron a hombres y 27 a mujeres en tanto que de las 36 lesiones benignas 16 correspondieron a hombres y 20 a mujeres. De los 76 pacientes con lesiones malignas 61 recibieron diversas modalidades de tratamiento, cirugía, radioterapia, quimioterapia y combinaciones de las tres. De las lesiones benignas se trataron 33 de 36 con una sola modalidad que fue la cirugía. El seguimiento a un año sólo se logró en nueve pacientes

Linfoma de la órbita / Lymphoma of the orbit

Los tumores primarios de la órbita son poco frecuentes, siendo los linfomas las neoplasias malignas en adultos más comunes de esta región. Los linfomas que aparecen en la órbita son tipo no-Hodgkin y existe evidencia que apoya la hipótesis de que, aunque aparezcan en forma aislada, representan un foco de proceso sistémico. El uso de técnicas inmunohistoquímicas ha demostrado que los tumores linfoides de la órbita, de una proliferación benigna linfoidea. Se reporta un caso clínico de linfoma primario de la órbita y se analizan su diagnóstico y posibilidades de tratamiento.