Inflammatory fibrous hyperplasia: a rare case in a child / Hiperplasia fibrosa inflamatória: um caso raro em Odontopediatria

ABSTRACT This paper aims to describe an inflammatory fibrous hyperplasia case caused by chronic irritation due to poor dental positioning after trauma. An 11-year-old female patient was sent to a dental specialty center with the complaint of a soft tissue growth in the place of an unerupted maxillary central incisor, causing her behavioral changes becoming more timid. After anamnesis and clinical examination it was noted that tooth 11 was in a vestibular position, covered with a hyperplastic lesion. Surgical treatment was performed and the histopathological exam revealed inflammatory fibrous hyperplasia. Over the course of the follow-up appointments, it was possible to observe improvement on the mentioned tooth and the patient's satisfaction. In face of the low prevalence of inflammatory fibrous hyperplasia, it is worth mentioning that the tooth positioning, outside its correct alignment in the arch, can cause repeated trauma to the mucosa, and then turning into etiological factor to inflammatory fibrous hyperplasia, affecting even children and adolescents. Thus, the dentistry must be alert to establish a diagnosis and clinical treatment, in addition to monitoring these cases.

RESUMO O objetivo deste trabalho é apresentar um caso de hiperplasia fibrosa inflamatória provocada por irritação crônica decorrente do mau posicionamento dental após trauma. Uma adolescente, 11 anos, foi encaminhada ao Centro de Especialidades Odontológicas, com queixa de que o incisivo central superior não havia erupcionado e em seu lugar havia surgido uma lesão de tecido mole, acarretando mudanças no comportamento da mesma que se tornou mais tímida. Após anamnese e exame clínico, constatou-se a presença do dente 11 em posição bastante vestibularizada, coberto por lesão hiperplásica. Foi realizado o tratamento cirúrgico e o resultado do exame histopatológico revelou que se tratava de hiperplasia fibrosa inflamatória. Durante as consultas para acompanhamento, foi possível observar a melhora no posicionamento do dente em questão e a satisfação da adolescente. Diante da baixa prevalência de hiperplasia fibrosa inflamatória na população infantil, vale ressaltar que o posicionamento do dente, fora do seu alinhamento correto no arco, pode provocar traumas repetidos em mucosa e, com isso, tornar-se fator etiológico para hiperplasia fibrosa inflamatória, acometendo, inclusive, crianças e adolescentes. Assim, o cirurgião dentista deve estar atento para estabelecer um diagnóstico e tratamento clínico oportunos, além do acompanhamento destes casos.

Ear pruritus: a new otologic finding related to temporomandibular disorder.

This prospective clinical study evaluated the correlation among temporomandibular disorder (TMD), otologic manifestations, and parafunctional habits in a sample of 100 patients with TMD. The subjects were evaluated by clinical examination, use of a simplified anamnestic questionnaire for TMD diagnosis, and the investigation of otologic manifestations and parafunctional habits of the stomatognathic system. The prevalence of TMD and correlations with otologic manifestations and parafunctional habits were calculated. Patients ranged in age from 13 to 70 years, and 79.0% of the patients were between the ages of 30 and 59 years. Women represented 88.0% of the sample. Otologic manifestations were found in 92.0% of patients with TMD. Sex showed a significant correlation with severity of TMD (P = 0.024). A significant correlation was observed between female patients and both otalgia (P = 0.036) and ear pruritus (P < 0.001). Otalgia showed a significant association with the symptoms of TMD (P = 0.003). Significant correlations between severe TMD and otalgia (P < 0.001), tinnitus (P = 0.010), ear pruritus (P < 0.001), and aural fullness (P = 0.014) were also observed. Ear pruritus, otalgia, and aural fullness are the most common otologic manifestations in patients with TMD, showing a significant correlation with the female sex, severity of TMD, and frequency of TMD symptoms.

Decision making in third molar surgery: a survey of Brazilian oral and maxillofacial surgeons.

This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi-square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non-steriodal anti-inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.

Juvenile psammomatoid ossifying fibroma with massive mandibular involvement.

Juvenile psammomatoid ossifying fibroma (JPOF) is a histologic variant of an ossifying fibroma. While an ossifying fibroma varies in appearance, it consists of fibrocellular tissue and mineralized material. JPOF is a rare benign lesion; however, it can be extended locally and mimic a malignant tumor. It is considered a specific clinicopathologic entity, due to its occurrence in children and adolescents, the presence of psammomas, and its purported tendency for local aggressive growth and recurrence. It commonly affects the maxilla, nasal cavity, paranasal sinuses, and ethmoid region. This article describes a rare, aggressive case of a large JPOF that led to the total destruction of the mandible.

Bilateral mandibular dentigerous cysts: a case report / Cisto dentígero bilateral em mandíbula: relato de caso

Dentigerous cysts are frequently found in the maxilla. After radicular cysts, dentigerous cysts are those most commonly diagnosed, accounting for 20% of all jaw cysts. They are often asymptomatic and diagnosed incidentally during routine examinations. Clinical complications such as dental displacement, ectopic eruption, dental impaction, adjacent tooth root resorption, cortical expansion with facial asymmetry, paresthesia, pathological fracture, and even malignant transformation may occur. Despite these classical features, definitive diagnosis must always be based on histological examination. Most dentigerous cysts are solitary. The aim of this article is to report a case of bilateral mandibular dentigerous cysts in a non-syndromic patient and, through a literature review, present the available treatment modalities used successfully in this case.

Os cistos são frequentemente encontrados nos maxilares. Depois dos cistos radiculares, os cistos dentígeros são os mais comumente diagnosticados, constituindo cerca de 20% de todos os cistos maxilo-mandibulares. Frequentemente apresentam-se de indolores, sendo achados em exames de rotina. Complicações clínicas como deslocamentos de dentes, erupções ectópicas, impacções dentárias, reabsorção das raízes dos dentes adjacentes, expansão da cortical gerando assimetria facial, parestesia e fratura patológica podem ocorrer advinda à presença dessa afecção. Apesar das características clássicas, o diagnóstico definitivo deve sempre ser baseado através do exame histopatológico. A maioria dos cistos dentígeros apresenta-se de forma solitária; múltiplos cistos são raros e geralmente são encontrados em pacientes sindrômicos. Este trabalho tem como objetivo relatar um caso de cistos dentígeros bilaterais em mandíbula no qual a descompressão teve fundamental importância para o sucesso do caso.

Effect of surgical repair of the joint capsule in mandibular condyle fractures in adult rats.

PURPOSE: The aim of the present study was to assess histologic changes in the temporomandibular joint (TMJ) of adult rats subjected to unilateral fracture of the mandibular condyle and soft tissue injury. MATERIALS AND METHODS: The animals were divided into 2 groups: one had surgical treatment for soft tissue repair and the other had no soft tissue treatment. All histologic evaluations were performed according to the presence or absence of synovitis, vascularity, presence or absence of joint inflammation, and presence or absence of the articular disc. The contralateral TMJs also were evaluated. RESULTS: The results showed few histologic changes in the synovial membrane and joint disc for the 2 groups and in the synovial membrane and disc of the contralateral side, where indirect trauma occurred in the unoperated joint. CONCLUSION: This study showed that treating or not treating soft tissues does not change the treatment results of condyle fracture or interfere with TMJ pathosis.

Surgical management of multiple myeloma in the mandible: a case report.

Multiple myeloma (MM), solitary bone plasmacytoma, and extramedullary plasmacytoma are different types of plasma cell neoplasia, which is a lymphoid neoplastic proliferation of ß-cells. While MM is most frequently seen in the vertebrae and long bones, 30% of MM cases are found in the jaws. This case report presents a 58-year-old man with mandibular swelling; his medical history indicated he had a fracture of the humerus 1 month earlier. Panoramic radiography revealed a radiolucent lesion in the mandibular posterior region. Biopsy was performed and the histopathological examination indicated plasmocytoma. However, given the patient's dental and medical history, and the presence of multiple osteolytic lesions, the final diagnosis was MM. The patient underwent chemotherapy for the MM. To treat the pathological fracture of the jaw, a hemimandibulectomy was followed by the installation of a reconstructive plate.

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.

Transplante dentário: Atualização da literatura e relato de caso / Dental Transplantation: Literature Update and Case Report

Apesar dos grandes avanços da odontologia, com consequente diminuição das indicações de exodontia por doença periodontal e cárie, a prática da remoção de dentes que podem ser tratados de forma conservadora ainda é rotineira em locais onde a condição sócio-econômica é desfavorável. As terapêuticas possíveis frente a um dente perdido são geralmente por reabilitação protética, implantes e ortodontia, todavia são tratamentos que geralmente dependem de condição financeira. Desse modo, o transplante dental surge como uma opção de tratamento a todas as camadas sociais, sendo denominado por alguns pesquisadores de "prótese biológica". As principais indicações para a transferência de um dente natural do seu alvéolo para outro sítio estão relacionadas a cáries extensas, reabsorção radicular, doença periodontal, fratura coronorradicular, agenesia e aplasia de dentes, dentes inclusos. A técnica cirúrgica deve ser minimamente traumática para melhor prognóstico do dente a ser transplantado, uma vez que o ligamento periodontal não deve ser manipulado, por ser necessário à reparação dos tecidos periodontais.

Despite major advances in dentistry, with consequent reduction of the indications for extraction for periodontal disease and tooth decay, the practice of removing teeth may be treated conservatively is still routinely used in places where the socio-economic status is unfavorable. The therapeutic potential against a missing tooth are usually for prosthetic rehabilitation, implants and orthodontics, however, are treatments that often depend on financial condition. Thus, the dental transplant comes as a treatment option to all social strata, being called by some researchers "bioprosthetic". The main indications for the transfer of a natural tooth in its socket to another site is related to extensive caries, root resorption, periodontal disease, fractured coronorradicular, agenesis and aplasia of teeth, impacted teeth. The surgical procedure should be minimally traumatic to better prognosis of the tooth to be transplanted, since the periodontal ligament should not be manipulated by the need of periodontal tissue repair.

Prevalência de lesões bucais diagnosticadas no laboratório de patologia bucal da Universidade Tiradentes (2002- 2010) / Prevalence of oral lesions diagnosed in oral pathology laboratory of Tiradentes University (2002-2010)

Objetivo: Identificar as principais patologias do sistema estomatognático diagnosticadas no Serviço de Patologia Bucal da Universidade Tiradentes. Metodologia: A amostra foi constituída pelos laudos histopatológicos de tecidos bucais elaborados no período entre 2002 e 2010. os seguintes dados foram coletados: gênero e idade do paciente, localização da lesão e diagnóstico histológico. Resultados: Foram analisados 128 laudos, sendo 119 lesões benignas (92,9%) e 09 malignas (7,1%). Houve 17 diagnósticos histológicos diferentes, sendo os mais comuns a hiperplasia fibrosa inflamatória e a mucocele. o lábio inferior foi a região mais afetada. os pacientes apresentavam idades entre 3 a 82 anos com média de 36,8 anos, e a maioria era do gênero feminino (61,7%). Conclusão: As características básicas dos pacientes com lesões estomatognáticas diagnosticadas no serviço de patologia bucal da Universidade Tiradentes correspondem ao indivíduo do gênero feminino, com idade média de 36,8 anos, apresentando uma lesão em tecidos moles, principalmente no lábio inferior, sendo hiperplasia fibrosa inflamatória o diagnóstico mais comum.

Objective: To identify the oral diseases diagnosed at the Department of oral Pathology in Tiradentes University. Methodology: The sample consisted of the all histological reports of oral tissues prepared between 2002 and 2010. The following data were collected: patient age and gender, lesion location and histological diagnosis. Results: we analyzed 128 reports, 119 were benign lesions (92,9%) and 09 were malignant ones (7,1%). There were 17 different histological diagnosis being the most common the fibrous inflammatory hyperplasia and mucocele. The patients were aged between 3 and 82 years with an average of 36,8 years and most were female (61,7%). Conclusion: The basic characteristics of patients with stomatognathic lesions diagnosed at the oral Pathology Service of the University Tiradentes correspond to a female, mean age 36,8 years, with soft tissue lesion mainly in the lower lip being the most common diagnosis the fibrous inflammatory hyperplasia.

Piercing labial como corpo estranho / Lip piercing as a foreign body

O uso do piercing oral se tornou muito comum na última década. o uso disseminado desse adereço pode trazer consequências na região bucal, relacionadas à instalação e permanência deste. A presença de piercings como corpoestranho inserido nos tecidos orais é pouco relatada pela literatura. este artigo tem como objetivo realizar uma revisão da literatura sobre piercing bucal e relatar um caso adicional de piercing lábio como corpoestranho.

Oral piercing has become very common over the last ten years. The widespread use of piercing may have consequences in the oral region related to installation and maintenance. The presence of foreign body piercings inserted into the oral tissues is rarely reported in the literature. This article sets out to review the literature on oral piercing and report an additional case of lip piercing as a foreign body.

Evaluation of reliability and reproducibility of linear measurements of cone-beam-computed tomography.

OBJECTIVE: it was to evaluate intra- and interexaminer reliability and reproducibility of linear measurements in cone-beam tomography (CBCT) images. MATERIALS AND METHODS: CBCT scans were obtained from 50 patients of a private clinic. Two examiners located the landmarks twice in two-dimensional and three-dimensional images on different days, with images performed 1 week apart. Intra- and interexaminer reproducibility and reliability were analyzed. RESULTS: the measurement error (ME) did not show significant differences between intra- and interexaminers. The intraclass correlations (ICC) between the intra- and interexaminer readings obtained with the different methods showed almost perfect matches. The results demonstrated high examiner reproducibility for linear and volumetric parameters with high intraclass correlation coefficient (ICC) and coefficient of variation (CV). The ICC showed that the methodology was highly reliable and reproducible (ICC- >0.99 and CV <1.5%). CONCLUSION: the measurements demonstrated strong agreement between examiners and significant reliability and reproducibility. Therefore, this methodology can serve as a standard for linear measurement analysis of the topography of mandibular canal and osseous adjacent structures.

Evaluation of fixation techniques with titanium plates and Kirschner wires for zygoma fractures: preliminary study.

OBJECTIVE: The aim of the present study was to assess the quality of treatment using two reduction and fixation techniques for zygoma fractures. PATIENTS AND METHODS: A randomized clinical trial was carried out involving a sample of 10 patients with Knight and North type III, IV and V zygoma fractures divided into two groups. One group underwent the closed reduction technique and fixation with Kirschner wire and the other group underwent the open reduction technique and fixation with titanium plates. The groups were submitted to subjective evaluation based on the patient's perception of areas of deformity and paresthesia as well as the measurement of range of mouth opening and pain upon mouth opening in the preoperative (T0) and postoperative (T1) periods. The assessment of bone reduction quality was performed using quantifiable points (lateral wall of the orbit, anteroposterior projection of the zygoma and ocular globe projection), measured based on tomographic images. RESULTS: Seventy percent of the patients remained with paresthesia and 20% remained with the complaint of deformity at T1. Mouth opening range increased in both groups at T1. In the overall sample, mean total disjunction of the lateral wall of the orbit and the difference in the anteroposterior projection of the zygoma were reduced between T0 and T1 (4.36 mm to 1.25 mm and 6.94 mm to 2.86 mm, respectively). There was also a reduction in ocular globe projection in both groups between T0 and T1. CONCLUSIONS: Both techniques achieved adequate reduction of zygoma fractures in the postoperative period.

Conservative treatment of comminuted mandibular fracture involving maxillomandibular fixation with miniplates.

Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.

An impressive case of complete traumatic maxillofacial degloving.

By definition, degloving is skin and subcutaneous tissue detachment, most often affecting the limbs and extremities and occasionally the scalp. Degloving generally stems from high-energy trauma, but can also be intentional, such as in the case of planned surgical access in the anterior region of the mandible in oral-maxillofacial surgery. This paper describes an extreme case of complete traumatic maxillofacial degloving that caused partial avulsion of the soft tissues and maxilla. This is an extremely rare condition that has not previously been described in the literature, as the patient survived despite the risk of imminent death. This case report addresses the decisions made regarding the prevention of necrosis and infection that guided the emergency care and subsequent elective steps.

Osteotomia le fort i: aspectos de interesse no tratamento de nasoangiofibroma juvenil / Le fort i osteotomy: interest aspects in juvenile nasoangiobibroma management

O angiofibroma nasofaríngeo é um tumor benigno, de caráter fibrovascular e de ocorrência rara. Apresenta característica localmente agressiva e destrutiva e acomete, quase que exclusivamente, homens, com predileção pela fase da adolescência. O diagnóstico é feito por meio de exame clínico e de imagens, sendo contraindicada a biópsia incisional devido ao risco elevado de sangramento de difícil controle. O tratamento é a completa excisão cirúrgica, sendo a radioterapia reservado para os casos de recidivas e tumores extensos com vascularização incomum ou extensão intracraniana. Os acessos cirúrgicos utilizados para ressecção desse tumor incluem a abordagem transmaxilar (le fort I), transantral, transpalatal, combinada, endoscópica e outras. O trabalho aborda um relato de caso, relacionando os aspectos de interessa da osteotomia Le For I, suas vantagens e desvantagens no tratamento do Angiofibroma Juvenil Nasofaríngeo.

Nasopharyngeal angiofibroma is a rare and benign tumor that has a fibrovascular feature. It has been locally aggressive and destructive that affects almost exclusively male, especially on teens.The diagnosis has done by clinical examination and radiography, but incisional biopsy is contraindicated due to risk of bleeding with difficult control. The recommended approach has been a wide surgical excision with radiotherapy being reserved for cases of recurrence and tumor vasculature with unusual or extensive intracranial extension. The surgical approaches used for resection of these tumors include the approach transmaxillary (le fort I), transnasal, transpalatal, combined endoscopic and others. The paper addresses a case report, listing the aspects of the interest of Le Fort I osteotomy, advantages and disadvantages in the treatment of Juvenile Nasopharyngeal Angiofibroma.

Técnica cirúrgica para remoção intrabucal de sialólito

Sialólitos são estruturas calcificadas, que se desenvolvem nas glândulas salivares ou em seus ductos. Normalmente, são assintomáticos e de apresentam evolução lenta e caráter benigno. Métodos de diagnóstico incluem a inspeção e a palpação, além da verificação da quantidade e qualidade da saliva secretada. As radiografias convencionais ou as tomografias computadorizadas são úteis para a confirmação do diagnóstico e exata localização do sialólito. Durante as refeições e pela estimulação salivar, podem apresentar aumento de volume glandular e discreta sensação de desconforto. A incidência da sialolitíase é maior nas glândulas submandibulares, embora também ocorra nas sublinguais, parótidas e, mesmo, nas salivares menores. O presente trabalho objetiva realizar uma breve revista da literatura sobre sialólitos e relatar um caso clínico, enfatizando a importância de medidas conservadoras para a obtenção de êxito no tratamento.

Sialolithiasis are calcified structures that develop in the salivary glands or their ducts. They are usually asymptomatic and have a slow and benign. Diagnostic methods include inspection and palpation, and checking the quantity and quality of saliva secreted. The conventional radiographs or CT scans are useful to confirm the diagnosis and exact location of sialolithiasis. During meals and by stimulating saliva, may have glandular swelling and mild discomfort. The incidence is higher in the submandibular glands, although they also occur in the sublingual and parotid salivary even in the minors. The present work aims at a brief review of the literature on sialolithiasis and report a clinical case, emphasizing the importance of conservative measures to obtain successful treatment.

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.