Analgesia and side effects of codeine phosphate associated with paracetamol vs. paracetamol after the extraction of mandibular third molars: a randomized double-blind clinical trial using the split-mouth model.

PURPOSE: To assess the analgesia and side effects of codeine phosphate associated with paracetamol (test medication) as compared to paracetamol (control medication) after the extraction of impacted mandibular third molars. MATERIALS AND METHODS: Forty-seven patients removed the right and left impacted mandibular third molars. After one surgery, patients took the test medication and after the other surgery, they took the control medication. Patients with exacerbated pain were prescribed to use the rescue medication instead of the medication initially administered and were included in the rescue group. They were evaluated for 7 days postoperatively, and the mean score of the visual analogue scale (VAS) of pain between test and control medications was assessed by the Poisson distribution. The side effects of these medications were assessed by the patient's complaints. A P value of < .05 was considered to be statistically significant. RESULTS: The mean score of the VAS of pain was not statistically different between test and control medications in the non-rescue group, but it was significantly greater in patients previously using paracetamol in the rescue group. The most common side effects reported in both groups, predominantly in patients using the test medication, were drowsiness, dizziness, and nausea. CONCLUSION: The use of codeine phosphate associated with paracetamol after the extraction of impacted mandibular third molars is a better choice to control the postoperative pain rather than paracetamol, but with more side effects, which are clinically acceptable.

The importance of early diagnosis of large lipomas in the maxillofacial region / Importancia del diagnóstico precoz de los lipomas de células grandes en la región maxilofacial

Lipoma is a benign tumor composed of proliferation of mature fat cells interspersed by fibrous connective tissue, blood vessels and muscles, delimited by a thin capsule. Although it represents a mesenchymal neoplasm most common human body, are rare occurrences in the oral cavity. Presents clinical and histopathological variables that do not alter their prognosis. The pathogenesis is still uncertain, although some authors consider heredity and endocrine disorders as possible causes. Occurs with greater prevalence in obese people, although their metabolism is completely independent of the normal body lipid metabolism. The clinical diagnosis of oral lipoma is the view of a nodular mass, soft, asymptomatic, flat surface, without ulceration and limited growth. The continuing growth of the lesion may cause difficulty in chewing, speech, dental adaptation and change in facial aesthetics of the patient, requiring surgical excision of the lesion. The final diagnosis is by histopathological examination. Aims to present a literature review and clinical cases of a retrospective study of 61 cases of lipomas diagnosed in pathological service between 1978 and 2009, among the 10 573 reports during that same period. It emphasizes the special cases of large lipomas of the maxillofacial region, and the importance of early diagnosis of these lesions. A dental surgeon should be able to diagnose lipomas in an early stage in the maxillofacial area avoiding a massive growth of these lesions(AU)

El lipoma es un tumor benigno compuesto por la proliferación de células adiposas maduras entremezcladas con el tejido conectivo fibroso, los vasos sanguíneos y/o músculos, delimitado por una fina cápsula. Aunque representa un neoplasma del mesénquima muy común del cuerpo humano, tiene raras ocurrencias en la cavidad bucal. Presenta variables clínicas e histopatológicas que no alteran su pronóstico. La patogénesis sigue siendo incierta aunque algunos autores consideran que los trastornos hereditarios y endocrinos son causas posibles. Ocurre con una mayor prevalencia en las personas obesas, aunque su metabolismo es totalmente independiente del metabolismo normal de los lípidos corporales. El diagnóstico clínico del lipoma bucal está relacionado con una masa nodular, blanda, asintomática, de superficie plana, sin ulceración y de crecimiento limitado. El continuo crecimiento de la lesión pudiera crear dificultad al masticar, al hablar, en la adaptación dental y cambio en la estética facial del paciente requiriendo la escisión de la lesión. Presentar una revisión de la literatura y de los casos clínicos de un estudio retrospectivo de 61 casos de lipomas diagnosticados en el servicio de patología entre 1978 y 2009 entre los 10 573 informes hechos durante ese mismo período. Se enfatizan los casos especiales de lipomas grandes de la región maxilofacial y la importancia del diagnóstico temprano de estas lesiones. Un cirujano dental debe ser capaz de diagnosticar los lipomas en una etapa temprana en el área maxilofacial para evitar un crecimiento masivo de estas lesiones(AU)