Accuracy of MRI, CT, and Ultrasound imaging on thickness and depth of oral primary carcinomas invasion: a systematic review.

OBJECTIVES: The aim of this study was to perform a systematic review to assess the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI), computed tomography (CT), and intraoral ultrasound (US) to determine the depth of invasion (DOI) and/or tumor thickness (TT) in oral cavity cancers, with histopathological evaluation as the gold standard. METHODS: Articles whose primary objective was to evaluate the accuracy (sensitivity and specificity) of MRI, CT, and US imaging to assess DOI and/or TT were searched in six major electronic databases, in addition to three grey literature databases. The methodological quality of the selected studies was evaluated by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS: Twelve studies met the inclusion criteria and underwent qualitative analysis: six studies on MRI, three on US, and one on CT. The accuracy values for MRI ranged from 67 to 83%, with sensitivity values above 80% and specificity above 75%. For US, mean values of sensitivity ranged from 91 to 93%. For CT, accuracy was 75%. CONCLUSIONS: For the application of US, CT, MRI, good accuracy was reported in DOI and/or TT, as evaluated in the preoperative period. US offered advantages for detection of small lesions.

Anesthetic Efficacy of an Alternative Inferior Alveolar Nerve Block Technique Using an Extra-Short Needle: A Double-Blind Randomized Non-Inferiority Trial.

PURPOSE: Inferior alveolar nerve block (IANB) is a frequently used anesthetic technique for restorative and surgical procedures in the mandible and its success rate usually ranges from 80 to 85%. Thus, this study aimed to compare the anesthetic efficacy of an alternative technique named superficial nerve block (SNB)-which consists of a modified approach using an extra-short needle inserted 10 mm deep and on a higher injection site to the conventional technique (CT) for IANB in healthy individuals. METHODS: About 20 participants received both SNB and CT with 1.8 mL of 2% lidocaine and 1:100,000 epinephrine. Thermal tests were performed 6 times, every 2 min, on the inferior canine and first molar to determine the success rate and anesthesia onset. Assessments were repeated at 20, 40, and 60 min to determine anesthesia duration. Sensitivity of lips and tongue was tested by clamp pressure. Pain perception during injection was assessed by a 100 mm visual analog scale (VAS). RESULTS: The success rate in accordance with anatomical location was molars (SNB = 90%; CT = 85%), canines (SNB = 25%; CT = 70%), lips (SNB = 45%; CT = 95%), and tongue (SNB = 85%; CT = 95%). Significant differences were found for canines (P = .012) and lips (P < .002). Moreover, median anesthesia onset was: molars (SNB = 6 min; CT = 4 min), canines (SNB = 6 min; CT = 6 min), lips (SNB = 10 min; CT = 6 min), and tongue (SNB = 8 min; CT = 4 min), whereas median duration was molars (SNB = 60 min; CT = 60 min), canines (SNB = 20 min; CT = 60 min), lips (SNB = 60 min; CT = 60 min), and tongue (SNB = 60 min; CT = 60 min). A significant difference was found for anesthesia onset on molars (P = .024) and lips (P = .009). Pain scores on VAS were SNB (median = 8.5 mm) and CT (median = 10.0 mm) (P = .398). CONCLUSIONS: In healthy individuals, the anesthetic effects of SNB were noninferior to CT in molars and tongue, although efficacy was considerably inferior in anterior teeth and lips.

Dystrophic calcification and respiratory metaplasia in the epithelial lining of odontogenic cysts: a study of 362 odontogenic cysts in a Brazilian population and literature review.

PURPOSE: Main study: undertake a histological study of odontogenic cysts (OC) to determine the prevalence of dystrophic calcification and metaplasia to respiratory epithelium on a Brazilian population. LITERATURE REVIEW: to review the literature for studies that investigated the prevalence of respiratory metaplasia and dystrophic calcification on OC. METHODS: Main study: a retrospective histopathological evaluation was made of the archives from a pathology laboratory. A total of 362 cases diagnosed as OC were identified; they were analyzed by two expert observers to determine the presence of dystrophic calcification and respiratory metaplasia. The association with sex, age and anatomic location was performed through statistical analysis. LITERATURE REVIEW: a critical literature review was undertaken. Two main electronic databases (PubMed and LILACS) were searched. Retrospective studies of histological evaluation that determined the prevalence of epithelial metaplasia and dystrophic calcification on OC, with at least 10 cases, were included; their findings were summarized and discussed. RESULTS: Main study: the histological evaluation of OC revealed the presence of respiratory epithelium in 25 cases (6.9%) and dystrophic calcification in 24 cases (6.6%). Positive association was found to dystrophic calcification on residual cyst and age; respiratory metaplasia on OC and sex; respiratory metaplasia on residual cyst and gnatic bone; respiratory metaplasia in OC and gnatic bone; dystrophic calcification in OC and anatomic site of mandible. LITERATURE REVIEW: eleven studies were included in the literature review, and respiratory metaplasia ranged from 0.0% to 19.2% while dystrophic calcification ranged from 2.5% to 40.5%. CONCLUSIONS: the histological evaluation of this study found 6.9% of prevalence of respiratory metaplasia and 6.6% of dystrophic calcification, which is in accordance with the literature reviewed. Therefore, these phenomena must be taken into account in routine diagnosis services.

Hybrid ameloblastoma and central giant cell lesion: Challenge of early diagnosis.

Hybrid lesions encompass the occurrence of different entities in one lesion. A 67-year-old woman was referred to the Oral and Maxillofacial Surgery Service for treatment of mandibular Central Giant Cell Lesion (CGCL) previously diagnosed. Intraoral examination revealed edentulism and a painless swelling extending from the alveolar ridge to the buccal vestibule with hard consistency covered by normal mucosae, with unknown duration. Panoramic radiograph revealed a large, multilocular and well-defined radiolucent lesion extending from the region of left mandibular lateral incisor teeth to right mandibular first molar with no evidence of osseous perforation. Initially, a treatment with intralesional injection of corticosteroids was performed. After 18 months of treatment, an increase in size of the osteolytic lesion was noted. An incisional biopsy was carried out and the microscopic examination revealed a unicystic ameloblastoma associated to CGCL. It was performed marsupialization and later the enucleation of residual lesion. The follow-up remains being performed. Key words:Hybrid lesion, central giant cell lesion, ameloblastoma.

Diagnostic Challenge and Clinical Management of Juvenile Mandibular Chronic Osteomyelitis.

Juvenile mandibular chronic osteomyelitis (JMCO) is a rare, idiopathic disease of chronic bone inflammation without suppuration, sinus tract formation, or sequestration. As the name suggests, this condition predominately affects children. The few cases of JMCO reported in the literature describe different treatments, and thus a standard therapy protocol has not yet been established. The aim of this paper is to report a clinical case in a 9-year-old girl that was misdiagnosed and unsuccessfully treated for 1 year. After experiencing persistent symptoms, a correct diagnosis was subsequently rendered based on the physical and radiographic examination as well as successful treatment with non-steroidal anti-inflammatory drugs (NSAIDs). The patient received drug therapy followed by periods of remission over a 4 year follow-up period. Diagnosis and treatment of JMCO is a challenge given the rarity and nonspecific signs and symptoms of this condition. Treatment with NSAIDs and regular follow-up is a conservative option for these patients.

Effects of sclerosing agents on head and neck hemangiomas: A systematic review.

BACKGROUND: The aim of this study was to systematically review the literature for studies that investigated the effects of sclerosing agents on head and neck hemangiomas. MATERIAL AND METHODS: Clinical trials, cohort studies, and descriptive studies were considered eligible and selected in a two-phase process. Six main electronic databases, in addition to three grey literature databases, were searched. Risk of bias (RoB) was assessed using the "Meta-Analysis of Statistics Assessment and Review Instrument" checklist. From fifty-six considered eligible, five were finally included. RESULTS: One article were judged at low, one at moderate, and three at high RoB. The sclerosing agents investigated were sodium tetradecyl sulphate (n=2), ethanolamine oleate (n=1), pingyangmycin (n=1) and bleomycin (n=1). Overall, good results were achieved on the treatment of head and neck hemangiomas with intralesional sclerotherapy. Most commonly reported adverse effects included pain, swelling, fever, necrosis, transient facial palsy, and anorexia. CONCLUSIONS: Considering the limited number of included studies, intralesional sclerotherapy on the management of HN hemangiomas presented overall good results with minor adverse reactions, especially in regards to smaller lesions. Key words:Sclerotherapy, sclerosing solutions, vascular neoplasms, hemangioma.

Human Dental Pulp Stem Cells in Rat Mandibular Bone Defects.

This study aimed to evaluate the use of human dental pulp stem cells (hDPSCs) in non-critical-sized mandibular bone defects in rats. hDPSCs from permanent teeth were isolated and engrafted in mandibular bone defects in rats for 7, 14, and 28 days; bone defects without cells formed the control group. Samples were evaluated by scanning electron microscopy (SEM), light microscopy (hematoxylin and eosin staining), and the regeneration area was measured by the Image J program. Before surgery procedures, the human dental pulp cells were characterized as dental pulp stem cells: fusiform morphology, plastic-adherent; expression of CD105, CD73, and CD90; lack of expression of CD45 and CD34, and differentiated into osteoblasts, adipocytes, and chondroblasts. The results indicated that within 7 days the control group presented a pronounced bone formation when compared with the treated group (p < 0.05). After 14 days, the treated group showed an increase in bone formation, but with no statistical difference among the groups (p > 0.05). In the final evaluated period there was no difference between the control group and the treated group (p > 0.05). There was a significant difference between 7 and 14 days (p < 0.05) and between 7 and 28 days (p < 0.05) in the treated group. In conclusion, there is no evidence that the use of hDPSCs in the conditions of this study could improve bone formation in non-critical-sized mandibular bone defects.

Effect of organic silicon, methylsulfonylmethane, and glucosamine sulfate in mandibular bone defects in rats.

Organic silicon (OS), glucosamine sulfate (GS), and methylsulfonylmethane (MSM) have been related to bone and connective tissue health and have been considered as basic therapy for osteoarthrosis disorders. Therefore, the aim was to analyze the effect of the association of these three components in mandibular bone defects in rats. Nine rats were used for histocompatibility test. In each animal was implanted the composition (70% OS, 15% GS, 15% MSM) and gutta percha (control) under the dorsal subcutaneous tissue. The samples were collected at 7, 14, and 21 days post-surgery and inflammatory events analyzed. In sequence, the composition was engrafted in mandibular bone defects of nine rats; bone defects without treatment were the control group. Analyses were performed at 7, 14, and 28 days post-surgery and samples were evaluated by scanning electron microscopy (SEM). For the histocompatibility test, both groups had a moderate inflammatory process at 7 days post-surgery and mild inflammatory process at 14 and 21 days. But in SEM analysis, the composition promotes an extensive reabsorption in cortical and crest alveolar bone, and great tooth root reabsorption. In conclusion, although the composition had positive result in the histocompatibility test, its direct application in mandibular bone defects caused intense resorption.