A Rare Malignant Peripheral Nerve Sheath Tumor of the Maxilla Mimicking a Periapical Lesion.

Malignant peripheral nerve sheath tumor is a malignant neoplasm that is rarely found in the oral cavity. About 50% of this tumor occurs in patients with neurofibromatosis type I and comprises approximately 10% of all soft tissue sarcomas of head and neck region. Intraosseous malignant peripheral nerve sheath tumor of the maxilla is rare. This article is the first to address malignant peripheral nerve sheath tumor of the maxilla presenting as a periapical radiolucency on nonvital endodontically treated teeth in the English medical literature. Surgical approaches to malignant soft tissue tumor vary based on the extent of the disease, age of the patient, and pathological findings. A rare case of intraosseous malignant peripheral nerve sheath tumor is reported in a 16-year-old woman. The patient presented clinically with a pain involving the upper left incisors region and with defined unilocular periapical radiolucency lesion involved between the upper left incisors. An incisional biopsy was made. Histological and immunohistochemical examination were positive for S-100 protein and glial fibrillary acidic protein showed that the lesion was an intraosseous malignant peripheral nerve sheath tumor of the maxilla. Nine years after the surgery, no regional recurrence was observed.

Abordagem cirúrgica em paciente portador da disostose cleidocraniana / Surgical approach in patient with dysostosis cleidocranial

A disostose cleidocraniana (DCC) foi descrita e conceituada, pela primeira vez, em 1897, por Marie e Sainton. O padrão de herança é autossômico dominante, porém, em alguns casos, interferências externas no período fetal poderiam causar mutações genéticas, impedindo a transformação de células-tronco mesenquimais em osteoblastos. Essa patologia é caracterizada por malformações cranianas, anormalidades nas clavículas, dentes supranumerários e retenções dentárias. Estudos radiológicos e genéticos são extremamente importantes para o seu diagnóstico preciso. O presente trabalho objetiva apresentar um tratamento cirúrgico dentário em paciente portador dessa patologia.

The Cleidocranial dysostosis (CCD) was described and conceptualized for the first time in 1897 by Marie and Sainton. The pattern of in heritance is autosomal dominant but, in some cases, externalinterference in the fetal period could cause genetic mutation preventing the transformation of mesenchymal stem cells into osteoblasts. This pathologyis characterized by cranial malformations, abnormalities of the clavicles, supernumerary teeth and dental retentions. Radiologicalstudies are extremelyimportanttoa precise diagnosis. Thisstudy aims to present a dental surgicaltreatment in patientswiththispathology.

Cervical Necrotizing Fasciitis Caused by Dental Extraction.

Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.

Evaluation of changes in nasal airway in patients having undergone surgically assisted maxillary expansion.

INTRODUCTION: Surgically assisted maxillary expansion (SAME) is used to treat transverse maxillary discrepancies. The effect of this technique on the nasal airway has been the subject of a large number of studies. OBJECTIVE: The aim of the present study was to identify changes in the nasal airway in patients having undergone SAME. MATERIALS AND METHODS: A prospective study was carried out on a sample of 10 patients having undergone SAME who agreed to participate in all phases of the study. Data acquisition involved a questionnaire, Glatzel mirror, and computed tomography measurements in both the preoperative and postoperative periods. RESULTS: Nasal width increased in all patients following SAME (mean increase: 1.29 mm). The mean opening of the intermaxillary space was 5.30 mm. The postoperative nasal airway was larger in 8 patients (80%), with a mean increase of 0.30 cm(2) (18.52%). A significant overall increase (P < 0.05) in the nasal valve angle occurred in the postoperative period. The use of the Glatzel mirror revealed a smaller area of condensation in the postoperative period in only 1 patient. CONCLUSIONS: The nasal airway underwent a positive change following surgically assisted maxillary expansion. Moreover, the nasal valve angle is suggested as a new parameter for the analysis of this improvement.

Osteoma em mandíbula: quando tratá-lo cirurgicamente / Osteoma of the mandible: when to treat it surgically

Osteomas são tumores benignos, que se desenvolvem a partir do osso maduro compacto ou esponjoso. São normalmente detectados na região bucomaxilofacial e raramente, em outros ossos. Os locais de ocorrência mais frequentes são a mandíbula e os seios paranasais. Afetam igualmente ambos os sexos, e sua prevalência é mais comum em adultos jovens, tendo sua origem associada a anomalias congênitas, à inflamação crônica, atividade muscular, aos distúrbios embrionários e ao trauma. No presente artigo,é relatado o caso de um jovem que se queixava de aumento de volume em região submandibular direita, com evolução de 9 meses. Apresentava queixa álgica ao realizar movimentos de flexão lateral e rotação da cabeça para ambos os lados. Ao exame tomográfico da face, apresentaram uma imagem hiperdensa, de formato oval e superfície irregular adjacente à cortical óssea de corpo mandibular direito. Com hipótese diagnóstica de osteoma, o paciente foi submetido à cirurgia sob anestesia geral, para a excisão da lesão. Após a peça cirúrgica ser enviada para análise, o laudo histopatológico confirmou diagnóstico de osteoma compacto. Já no décimo quarto dia pós-operatório, o paciente não mais apresentava dor, ao realizar movimentação cervical.

Osteomas are benign tumours which develop from mature compact or cancellous bone. They are normally detected in the maxillofacial region and rarely in other bones. The most common sites of occurrence are the mandible (angle, condyle and inferior edge region) and the paranasal sinuses. They affect both sexes equally and their prevalence is greater in young adults, their origin being associated with congenital anomalies, chronic inflammation, muscle activity, embryonic disorders and trauma. This paper reports the case of a young man who complained of swelling in the right submandibular region with nine months' progression. He complained of pain when performing lateral flexion and rotation of the head to both sides. A CT scan of the face showed an oval-shaped hyperdense image and an uneven surface adjacent to the cortical bone of the right mandibular body. With a hypothetical diagnosis of osteoma, the patient underwent surgery under general anesthesia for the excision of the lesion. After the specimen was sent for analysis, the histopathological report confirmed the diagnosis of a compact osteoma. By the fourteenth postoperative day the patient no longer felt any pain on cervical spine movement.

Intraoral approach for removal of large sialolith in submandibular gland.

Sialolithiasis is a benign pathology that occurs most frequently in the submandibular salivary gland due to its anatomic features. Depending on the size and degree of calcification, a sialolith can be visible in radiographic examinations. Patients commonly experience pain and/or edema when the ducts are obstructed. The authors report two cases of sialolithiasis of the submandibular gland after searching for the source of swelling in the submandibular region. The diagnosis was confirmed by clinical and tomographic examinations. Despite the considerable size of the sialoliths, treatment consisted of the removal of the calcified mass using an intraoral surgical approach. The prognosis is often good and there is generally no recurrence of the condition.

Repercussions of surgically assisted maxillary expansion on nose width and position of septum and inferior nasal conchae.

The aim of the present study was to assess the clinical and radiographic repercussions of surgically assisted maxillary expansion on the septum, nasal cavity and nasal conchae. The sample was made up of 15 patients with skeletal maturity (9 females and 6 males between 16 and 45 years of age) and maxillary transverse deficiency. Assessments were performed through anterior rhinoscopy and frontal cephalometric radiographs on three occasions: (T0) preoperative period, (T1) locking of the expander and (T2) six months following the locking procedure. An increase was observed in the basal portion of the pyriform aperture and distances between the lateral wall of the basal portion of the pyriform aperture and the septum. The radiographic exam revealed that the nasal septum did not undergo any statistically significant change in its position. Moreover, no significant changes in the position of the nasal septum or nasal conchae were detected throughout the three evaluation times. The results suggest that surgically assisted maxillary expansion is capable of widening the basal portion of the pyriform aperture, with little repercussion on the anterior position of the nasal septum and inferior nasal conchae.

Tratamento cirúrgico de sialólito em glândula submandibular - relato de caso / Surgical Treatment of calculi in submandibular gland - case report

A obstrução das glândulas salivares por cálculos está entre as mais frequentes afecções dessas estruturas anatômicas. Estudos mostram que cerca de 80 a 90% deles acomete a glândula submandibular. Inúmeras formas de tratamento são empregadas na remoção de cálculos do sistema ductal. O tratamento pode variar desde o acompanhamento clínico até técnicas cirúrgicas intra ou extraorais, com preservação ou excisão da glândula. Fatores, como o estado geral do paciente, experiência do cirurgião, tamanho, forma e localização do cálculo, influenciam diretamente na escolha do tipo de tratamento. Este trabalho tem como propósito relatar um caso clínico de excisão cirúrgica de cálculo salivar, com dimensões incomuns, em glândula submandibular pela técnica intraoral. Objetiva-se, ainda, realizar uma discussão acerca dos tipos de tratamento e seus riscos e benefícios.

The obstruction of the salivary glands for calculi is among the most frequent disease of these anatomical structures. Studies show that about 80 to 90% of them affects the submandibular gland. Numerous forms treatment are employed in the removal of calculis of the ductal system. Treatment can range from clinical follow-up to intra or extraoral surgical techniques with preservation or excision of the gland. Factors such as the state of the patient, surgeon experience, size, shape and location calculation directly influence the choice of treatment. This work aims to report a case of surgical excision of salivary calculis with unusual dimensions, in submandibular gland for intraoral technique. The objective is to also hold a discussion types of treatment and its risks and benefits.

Avaliação clínica da expansão maxilar cirurgicamente assistida / Avaliação clínica da expansão maxilar cirurgicamente assistida Clinical evaluation of surgically assisted maxillary expansion

Na maxila, a dimensão transversal é a que menos cresce, podendo ocasionar uma deficiência transversal maxilar. A correta correção dessas deformidades em pacientes adultos, para alcançar uma oclusão funcional estável, muitas vezes, se faz necessária uma expansão maxilar cirurgicamente assistida, na qual consiste basicamente em um procedimento auxiliar, com o objetivo de liberar as áreas de maior resistência maxilares, por meio de osteotomias, permitindo, assim, a obtenção de uma expansão maxilar satisfatória. Diante do exposto, o presente estudo tem como objetivo avaliar clinicamente os resultados obtidos em uma série de casos de pacientes submetidos à expansão maxilar cirurgicamente assistida e discutir sobre a literatura vigente.

The maxillary transverse dimension is the least that grows, can cause a maxillary transverse deficiency. The surgically assisted maxillary expansion (SAME) it is often necessary in adult patients, to achieve a stable and functional occlusion. SAME consists of a procedure to assist for release the greatest resistance maxillary region through osteotomies, thus obtaining the maxillary expansion satisfactorily. The aim of this study is evaluate the results of patients who have undergone maxillary expansion assisted surgery and discuss the current literature.

Cisto ósseo aneurismático: relato de caso / Aneurysmatic osseous cyst: a case report

O cisto ósseo aneurismático é uma lesão benigna e rara dos maxilares, que geralmente possui comportamento local agressivo. O crescimento e surgimento rápido, áreas osteolítica e abaulamentos das corticais são características clínicas comuns. Os exames complementares de imagem e histopatológico são essenciais para o correto diagnóstico e planejamento cirúrgico. O objetivo desse estudo é apresentar um relato de caso de cisto ósseo aneurismático, tratado cirurgicamente por isso de enucleação, e discutir a patogênese da doença, abordando seus aspectos clínicos.

The aneurysmatic osseous cyst is a benign and rare lesion of the maxillofacial complex. Its behavior is usually aggressive. Its rapid growth and onset, osteolytic areas and cortical expansion are common clinical characteristics. Radiographic imaging and a histopathological examination are essential for the correct diagnosis and planning of the surgery. The aim of this study is to present a case report of an aneurysmatic osseous cyst treated by enucleation and to discuss the etiology, addressing its clinical features.

Tratamento de fratura de mandíbula: miniplacas e parafusos x lag screws - relato de caso / Management of the mandible fracture: miniplates and screws vs. lag screws - case report

Dentre os materiais utilizados para a fixação cirúrgica de fraturas mandibulares, as placas e parafusos de titânio e os parafusos transcorticais são os mais amplamente empregados. Estes são indicados para repararem fraturas transversalmente oblíquas da mandíbula, aplicando-se força compressiva aos fragmentos fraturados, usando-se três ou mais parafusos, entretanto, são contra-indicados para o tratamento de fraturas cominutivas, onde as placas e parafusos de titânio apresentam-se mais adequadas. Este trabalho objetiva relatar dois casos clínicos de redução cirúrgica de fraturas de mandíbula, oblíqua e completa, utilizando, respectivamente, lag screws e placas e parafusos de titânio, enfocando, principalmente, os aspectos relacionados ao uso e indicações destes materiais de osteossíntese.

Among the materials used for surgical fixation of jaw fractures, the titanium plates and screws and the lag screws are the most widely used. These are indicated to repair fractures of the mandible transversely oblique, applying compressive force to the fractured fragments, using three or more screws, however, are contraindicated for the treatment of comminuted fractures, where the titanium plates and screws are more appropriate. This work aims to report two cases of surgical reduction of mandible fractures, oblique and complete, using, respectively, lag screws and titanium plates and screws, focusing on aspects related to the use and indications of osteosynthesis materials.

Avaliação clínico-radiográfica dos caninos após tratamento orto-cirúrgico / Clinical-radiographic analysis of canines after orthodonthic-surgical treatment

A ocorrência de caninos inclusos é uma condição comum na população que procura tratamento ortodôntico e a excelência da terapia ortodôntico-cirúrgica traduz-se na correção da oclusão, harmonia do sorriso, saúde periodontal, manutenção da saúde pulpar e estabilidade pós-tratamento. Para obtenção de tais condições, ressalta-se a importância de um trabalho multidisciplinar. O presente trabalho objetiva abordar os aspectos clínicos e radiográficos dos caninos inclusos submetidos à tratamento orto-cirúrgico. O estudo foi realizado na Faculdade de Odontologia de Pernambuco (FOP-UPE) no período de 2000 a 2007. Realizou-se uma avaliação clínica (cor, forma da gengiva, posição no arco) e radiográfica, (dilaceração, lâmina dura, presença de processo periapical). Como resultado, observamos que 4 pacientes (23,5%) apresentaram retração gengival com hipersensibilidade associada, apenas um paciente (6,25%) apresentou mobilidade dentária, nenhum dos dentes examinados apresentou alteração de forma e do total 14 dentes (82,35%) responderam positivamente ao teste de vitalidade pulpar. A avaliação Radiográfica foi realizada em 14 dentes, destes 07 (50%) apresentaram dilaceração radicular, 04 dentes (28,60%) estavam relacionados à odontomas, 02 dentes (14,28%) apresentaram reabsorção da crista óssea alveolar, 02 dentes (14,28%) mostraram calcificação intracanal. Tracionamento ortodôntico na amostra estudada aparece como um procedimento eficaz, seguro e reprodutível.

The occurrence of impacted canine is a common condition in the population who seeks orthodontic therapy and the excellence in orthodontic- surgical treatment leads to the correction of the occlusion, smile harmony, periodontal health, maintenance and stability of pulp tissue. To obtain these conditions, the study highlights the importance of a multidisciplinary work. This paper aim to address the clinical and radiographic findings of impacted canines who underwent ortho-surgical treatment. The study was conducted at the Faculty of Dentistry of Pernambuco (FOP-UPE) in the period of 2000 to 2007. Clinical parameters (color, gingiva aspect, arch position) and radiographic features (dilacerations, periapical inflammation) were observed. As a result, four patients (23.5%) had gingival recession associated with hypersensitivity, only one patient (6.25%) had tooth mobility, none of the teeth examined showed a change of form and 14 teeth (82.35 %) responded positively to vitality test. Radiographic evaluation was performed in 14 teeth, 07 of these (50%) had root dilaceration , 04 teeth (28.60%) were related to odontomas, 02 teeth (14.28%) had resorption of alveolar bone crest, 02 teeth ( 14.28%) showed intracanal calcification. Ortho-surgical treatment appears to be a safe, efficient and reproducible.

Congenital lipoma of the lip: a case report.

We describe a rare case of large congenital lipoma in the upper lip of a six-month-old infant. Surgical excision of the tumor was successful, with satisfactory esthetic and functional results.

Patient's perception of improvement after surgical assisted maxillary expansion (SAME): pilot study.

OBJECTIVE: Clinicians often assume that changes following orthognathic surgery are both physically and psychologically beneficial to the patient. The present study investigates patient perception regarding improvement after surgically assisted rapid maxillary expansion. STUDY DESIGN: A survey with twenty-three patients was carried out to identify satisfaction with the surgical outcome and assess whether the surgery met patient expectations. General information was also collected on schooling, age, gender, chief complaint and reasons for seeking treatment. RESULTS: Most patients (n = 19; 82%) were advised to undergo surgery by a dentist. Twenty-two (95%) patients reported being satisfied with the operation procedure. Twenty-one (91%) patients reported that the procedure met their expectations. Nineteen respondents would undergo the same operation again and would recommend treatment to others with similar problems. CONCLUSION: The need for surgery associated with orthodontic appliances to correct a transverse maxillary deficiency requires a proper explanation to patients regarding the procedure and postoperative period in order to ensure realistic expectations concerning the surgical goals.

Transmaxillary approach to the cranial base: an evaluation of 11 cases.

UNLABELLED: Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.

Patient’s perception of improvement after surgical assisted maxillary expansion(SAME): Pilot study

Objective: Clinicians often assume that changes following orthognathic surgery are both physically and psychologicallybeneficial to the patient. The present study investigates patient perception regarding improvement after surgicallyassisted rapid maxillary expansion.Study design: A survey with twenty-three patients was carried out to identify satisfaction with the surgical outcomeand assess whether the surgery met patient expectations. General information was also collected on schooling, age,gender, chief complaint and reasons for seeking treatment.Results: Most patients (n = 19; 82%) were advised to undergo surgery by a dentist. Twenty-two (95%) patients reportedbeing satisfied with the operation procedure. Twenty-one (91%) patients reported that the procedure met theirexpectations. Nineteen respondents would undergo the same operation again and would recommend treatment toothers with similar problems.Conclusion: The need for surgery associated with orthodontic appliances to correct a transverse maxillary deficiencyrequires a proper explanation to patients regarding the procedure and postoperative period in order to ensure realisticexpectations concerning the surgical goals (AU)

Passive drainage through the vestibular oblique incision in impacted inferior third molar surgery: a preliminary study.

The aim of the present study was to clinically evaluate the variables pain, swelling and trismus when two different suture techniques were applied in surgery of impacted lower third molars. The sample comprised 20 patients of both genders participating in the clinical trial at the Division of Oral and Maxillofacial Surgery, with an indication for the removal of bilaterally impacted lower third molars. They were divided into test and control groups. Complete suture was performed on the free and attached gums in the control group and only on the attached gum of the oblique vestibular incision in the test group. The results showed that the fact that the drainage of fluid through the suture was not obliterated led to diminution of pain 48 hours after surgery. No statistically significant differences were observed in relation to swelling, which diminished gradually in both groups. As regards the variable trismus, the test group presented a greater mouth opening throughout the evaluation, being statistically significant at 7 days. The probing depth, three months postoperatively, was found to be greater in the control group. This difference reached statistical significance for the vestibular distal region of the adjacent second molar. It is concluded that the strategy of not suturing the free gum of the oblique vestibular incision in the extraction of impacted lower third molars leads to the diminution of immediate painful symptomatology, but has no influence on the swelling.

Acesso transmaxilar à base do crânio: avaliação de 11 casos / Transmaxillary approach to the cranial base: an evaluation of 11 cases

O acesso cirúrgico à região de base do crânio é sempre difícil principalmente pelas estruturas anatômicas nobres associadas. A osteotomia maxilar proporciona visão direta à região de clivus e coluna cervical, além de apresentar uma menor morbidade em relação aos diversos acessos descritos na literatura. OBJETIVO: Avaliar 11 casos submetidos à osteotomia transmaxilar, descrevendo técnica cirúrgica, resultados e complicações pós-operatórias. PACIENTES E MÉTODOS: O estudo retrospectivo de onze pacientes foi submetido à cirurgia transmaxilar para acesso à região do tronco encefálico. Registros quanto à oclusão dentária, hemorragia trans e pós-operatória, necrose óssea e alterações de tecido mole foram estudados. Todos seguiram o mesmo protocolo cirúrgico e acompanhamento médio de dois anos. RESULTADOS: Após o tratamento todos os pacientes apresentaram melhora do quadro clínico e nenhum dano neurológico, hemorragia trans e pós-operatória ou intercorrências maiores foram identificadas. Dentre as complicações, em dois pacientes ocorreu fratura incompleta da maxila, dois apresentaram laceração da mucosa nasal e um apresentou como complicação tardia uma fístula bucossinusal. CONCLUSÃO: A osteotomia transmaxilar possibilitou adequado acesso a região de clivus para descompressão do tronco encefálico com baixo índice de complicações nesta série de casos.

Surgical access to the skull base is always difficult, especially because of the noble anatomic structures present there. Maxillary osteotomy provides direct view to the clivus region and the neck spine, and it also bears less morbidity when compared to the many other accesses described in the literature. AIM: to assess 11 patients submitted to transmaxillary osteotomy, describing the surgical technique and postoperative results and complications. MATERIALS AND METHODS: A retrospective study involving eleven patients submitted to transmaxillary approach to the brainstem. We studied dental occlusion, trans and postoperative bleeding, bone necrosis and soft tissue alterations. All followed the same surgical protocol and were followed up for two years. RESULTS: after treatment, all the patients improved in their clinical status and had no neurological complication, trans and postoperative hemorrhage or major complications were seen. Among the complications, two patients had incomplete maxilla fracture, two had laceration of their nasal mucosa and one had, as late complication, an oral-sinusal fistula. CONCLUSION: Transmaxillary osteotomy provided proper access to the clivus for brainstem decompression with low rate of complications in this series.

Utilização da osteotomia Le Fort I na abordagem cirúrgica de carcinoma epidermóide de base de crânio / Le Fort I Osteotomy as a Surgical Approach to Skull Base Epidermoid

O acesso para tratamento de lesões localizadas na região de base de crânio tem sido um desafio cirúrgico na história da neurocirurgia. A osteotomia Le Fort I é o resultado de décadas de aperfeiçoamento da Cirurgia Buco-Maxilo-Facial, que culminou numa osteotomia versátil, segura e satisfatória, a qual pode ser utilizada nos acessos para ressecções de tumores de base de crânio e seios paranasais, além de anomalias da coluna Buco-Maxilo-Facial, que culminou numa osteotomia versátil, segura e satisfatória, a qual pode ser utilizada abordagem cirúrgica no caso de um paciente com carcinoma epidermóide da região do clivo

The access to lesions located at the skull base has been a challenge in the history of neurosurgery. Le Fort I osteotomy resulted from the advancement of oral and maxillofacial surgery techniques which made the procedure flexible, secure and satisfactory. Osteotomy can be applied to resect central skull base and paranasal tumors as well as upper cervical spine anomalies. This paper describes in detail the use of Le Fort I osteotomy as a surgical approach to a patient with squamous cell carcinoma in clivus region