Uncommon Pigmented Carcinoma In Situ: Case Report and Brief Review.

Pigmented lesions of the oral mucosa encompass several benign and malignant conditions that may be a matter of concern under both clinical and histopathological views. We reported a case of a 62-year-old woman, presenting with an asymptomatic, deeply pigmented lesion on the soft palate. On examination, it appeared asymmetrical, with irregular borders and an area of ulceration. A biopsy, taken to rule out melanoma, revealed a pigmented carcinoma in situ. Throughout the tumor thickness, numerous interspersed melanocytes were found that did not extend to neighboring epithelium. These were large, richly dendritic, and presented abundance of melanin granules and small nuclei. Mild melanin incontinence was found. Scanty transfer of pigment to dysplastic epithelial cells was found through Fontana Masson staining. On immunohistochemical analyses, there were pancytokeratin-stained tumor epithelial cells; increased cell proliferation throughout the entire thickness of the tumor was emphasized by Ki-67 immunomarking. P16 was negative. The dendritic cells were selectively stained for S-100, HMB45 and Melan A. Wide spectrum in situ hybridization for human papillomavirus (HPV) was negative. Unfortunately, following diagnosis, the patient refused any treatment option. Pigmented squamous cell carcinoma with melanocyte colonization must be taken into account in the differential diagnosis of pigmented lesions of the oral cavity.

Influência do alinhamento das imagens por TCFC nas medidas lineares virtuais das relações entre implantes dentários: estudo laboratorial / The influence of different CBCT image alignment position on the virtual linear measurements of dental implant relationships: a laboratory study

Objetivo: verificar a variação das medidas lineares em função de angulações distintas dos implantes e dos alinhamentos diferentes das imagens de TCFC. Material e métodos: três mandíbulas artificiais de polietileno receberam 18 implantes dentários, com seis implantes em cada mandíbula, sendo: 1) dois angulados no sentido distal no lado direito posterior, 2) um angulado para vestibular e outro para lingual na região anterior, e 3) dois angulados no sentido mesial na região posterior esquerda. Com a mandíbula apoiada na mentoneira do equipamento e paralela ao plano horizontal, foram realizadas três aquisições tomográficas padronizadas, (voxel de 0,133 mm, FOV 6 x 8 cm, 89kV, 10 mA). Depois, foram realizadas uma medida perpendicular (da plataforma do implante ao rebordo mandibular) e outra inclinada (da plataforma do implante ao longo eixo do rebordo) nos cortes coronais e sagitais. As medidas foram realizadas com a base de mandíbula paralela ao plano horizontal e também após o volume ser rotacionado para o inferior no plano sagital. Os implantes foram numerados de um a seis e divididos em duplas. As medidas foram comparadas antes e após o alinhamento das imagens através do programa OnDemand3D. Resultados: foram observadas diferenças estatisticamente significantes entre as medidas realizadas nos implantes 1 e 2. Conclusão: as medidas lineares sofreram alteração em decorrência do posicionamento mandibular quando manipulado em software.

Objective: to verify the linear measure variation according to the distinct implants angulations and the different alignment from CBCT images. Material and methods: three polyethylene artifi cial models received 18 dental implants, 6 in each jaw, being: 1) two angled to distal on the right posterior side, 2) one angled to vestibular and another to lingual on the anterior region, 3) two angled to mesial way on the left posterior region. Each jaw was supported at a chinstrap of the equipment and parallel to the horizontal plane, and three standardized tomographic acquisitions were taken, (voxel size 0.133 mm, FOV 6 x 8 cm, 89kV, 10 mA). A perpendicular measure was made after the tomographic acquisitions (from the implant platform to the jaw border) and another inclined measure (from the implant platform to border long axis) both on coronal and sagittal acquisitions. Measurements were taken with the jaw base parallel to the horizontal plane and also when the volume was rotated to inferior on the sagittal plane. The implants were numbered from one to six and divided into couples. The measures were compared before and after image alignment by the OnDemand3D software. Results: statistically signifi cant differences were observed between the measurements performed on implants 1 and 2. Conclusion: the linear measurement values change in consequence of the jaw position when manipulated by the software.

Extramedullary Plasmacytoma Diagnosed in an HIV-Positive Patient by an Unusual Clinical Presentation.

The aim of this paper is to describe a case report of EMP in an HIV-positive patient. A 44-year-old, dark-skinned HIV-infected woman was referred to the Oral Diseases Treatment Center with a swelling at palate and left gingival fornix in the maxilla. Biopsy was taken and the oral lesion was diagnosed as EMP with well-differentiated plasma cells and restriction of the lambda light-chain. Skeletal survey was performed and no radiograph alterations were observed, thus supporting the diagnosis of EMP. Patient was referred to treatment and after two months of chemo and radiotherapy, an expanding lesion was observed in L5/S1 patient's vertebrae. Biopsy of the spinal lesion was consistent with lymphoma with plasmocitary differentiation, supporting the diagnosis of multiple myeloma (MM). Regarding the medical history, the final diagnostic was an oral extramedullary plasmacytoma with rapid progression into multiple myeloma. It is crucial to emphasize the relevance of HIV infection as a risk factor for both aggressive clinical behavior and unusual clinical presentation of extramedullary plasmacytoma cases.

Goldenhar Syndrome in a pediatric patient: a case report and review of literature / Síndrome de Goldenhar em um paciente infantil: relato de caso e revisão da literatura

ABSTRACT Goldenhar Syndrome is a rare, generally sporadic condition, whose physical manifestations include asymmetric incomplete facial development, epibulbar dermoids, auricular malformations e auricular appendices, vertebral anomalies, central nervous system disturbances, ocular irregularities and visceral abnormalities. Its etiology is not fully understood, with its incidence ranging from 1:3500 to 1:5600 live births, and a gender ratio of 3:2 (male: female), presenting more frequently in children with congenital deafness. The purpose of this case report was to describe clinical presentation of Goldenhar syndrome in a five-year old male with no significant family history, where almost all of the classic signs of the condition were present. Considering its involvement in craniofacial structures, its rarity, and its wide spectrum of symptoms and associated systemic abnormalities, knowledge of this condition is paramount for the dental surgeon.

RESUMO A Síndrome de Goldenhar é rara e suas principais manifestações físicas incluem assimetria e desenvolvimento facial incompleto, tumores dermoides epibulbares, malformações na orelha e apêndices auriculares, anomalias vertebrais, distúrbios no sistema nervoso central, irregularidades oculares e anomalias viscerais. A etiologia desta condição não é claramente esclarecida e apresenta-se geneticamente variável. A incidência da Síndrome de Goldenhar pode variar de 1:3500 até 1:5600 nascidos vivos e relação por sexo de 3:2 (masculino: feminino), apresentando mais frequentemente em crianças com surdez congênita. O objetivo deste trabalho é apresentar um caso clínico de Síndrome de Goldenhar em paciente infantil de 5 anos de idade do sexo masculino, sem história familiar relevante relacionada à síndrome e que apresenta características claras desta condição. Considerando o envolvimento das estruturas craniofaciais da Síndrome de Goldenhar, sua raridade e o amplo espectro de sintomas e anormalidades sistêmicas associadas, o conhecimento desta condição é primordial para o cirurgião-dentista.

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature / Sucesso no tratamento conservador de osteorradionecrose dos maxilares: relato de caso e revisão da literatura

ABSTRACT Osteoradionecrosis of jaws is one of the most serious complications of radiation therapy for head and neck malignancies. The management of osteoradionecrosis continues to be debated and there are few cases which can be resolved with conservative management. This paper presents a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man and highlights the conservative therapeutic management and 3-year follow-up period. We combined a conservative nonoperative therapy, including long-term antibiotic therapy and daily irrigation with chlorhexidine mouthrinses in a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man. At the follow-up, clinical aspect was resolved. A CBCT scan image and a three-dimensional (3D) reconstructed image revealed bone remodeling in a 3-year follow-up period .No sign of exposed bone could be seen. Follow-up 3 years later revealed that the conservative management posed was successful for osteoradionecrosis and the patient is currently under regular review.

RESUMO Osteorradionecrose dos maxilares é uma das complicações mais sérias da radioterapia para o tratamento de tumores de cabeça e pescoço. O manejo da osteorradionecrose continua sendo discutido e há poucos relatos de casos descrevendo modalidades de tratamento conservadoras. Este artigo apresenta um caso de osteorradionecrose na mandíbula de um paciente de 58 anos de idade, após a realização de exodontia e explora uma modalidade de tratamento conservador com um follow-up de três anos. Foram combinadas antibioticoterapia e irrigação diária utlizando clorexidina. Após três anos é possível observar a resolução do caso em imagens de tomografia computadorizada de feixe cônico e reconstruções 3D. As imagens evidenciam remodelação óssea após este período de acompanhamento e sem a presença de osso exposto. Pode-se concluir que a terapia proposta resultou em sucesso e o paciente continua em acompanhamento periódico.

Cryosurgery for the treatment of pediatric plunging ranula: a conservative management / Criocirurgia para tratamento de rânula mergulhante em criança: uma abordagem conservadora

Several methods of treatment for plunging ranulas have been described in the literature, such as: surgical treatment including the excision of the sublingual gland followed by transoral drainage of the pluging ranula, needle aspiration, excision of the ranula, cryosurgery and CO(2) laser excision. Marsupialization and micro-marsupialisation can be also recommended primarily to treat oral ranulas. The aim of this paper is to present the treatment of pediatric ranula with liquid nitrogen cryosurgery performed in a 8 year, 6-month-old male, without local anesthesia. We have outlined the current protocol of cryosurgery recommended in the management of ranulas, both clinical advantages and disadvantages, with emphasis on the clinical outcomes and also pediatric patients' safety. At the 1year follow-up visit, the lesion had disappeared completely. There was no recurrent lesion. Liquid nitrogen cryosurgery for management of ranulas may become a primary treatment modality prior to surgery in children.

Muitas modalidades de tratamento têm sido propostas para o tratamento da rânula mergulhante, dentre elas: tratamento cirúrgico incluindo a excisão da glândula sublingual seguida da drenagem transoral da rânula mergulhante, aspiração, e criocirurgia e excisão com laser de CO2. Além dessas modalidades, a marsupialização e micro-marsupialização também podem ser recomendadas para o tratamento de rânulas intraorais. O objetivo deste trabalho será apresentar um caso clínico de rânula mergulhante em um paciente infantil de 8 anos e 6 meses de idade. A lesão foi tratada por meio do uso da criocirurgia, realizada com nitrogênio líquido e sem a aplicação de anestesia local. Serão destacados o protocolo de utilização, vantagens e desvantagens, resultados alcançados e a segurança para o paciente durante o tratamento. Após um ano de acompanhamento, observou-se que a lesão desapareceu completamente e não houve recidiva. Pode-se concluir que o uso da crioterapia com nitrogênio líquido pode ser o tratamento de escolha em relação à cirurgia convencional em pacientes pediátricos.

Cryosurgery as an effective alternative for treatment of oral lesions in children.

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

A rare presentation of multiple talon cusps / Uma rara apresentação de múltiplas cúspides em garra

A talon cusp is a relatively rare dental developmental anomaly characterized by the presence of accessory cusp-like structure projecting from the cingulum area or cementoenamel junction. It is frequently found on the palatal surface of the maxillary anterior teeth in the permanent dentition. The etiology is controversial, but it is suggested that this condition has a multifactorial cause, including both genetic and environmental factors. Radiographically talon cusps are radiopaque structures, in which the enamel, dentin and occasionally the pulp can be seen. The alteration is generally asymptomatic, but it may cause clinical problems eventually. Early diagnosis is important to prevent occlusal interference, irritation of the tongue, pulpal necrosis, caries and periodontal alterations. Clinical management of talon cusps may be either conservative or radical, depending on the size and shape of the affected tooth. We report a rare case of talon cusps involving all six maxillary anterior teeth in a 20-year-old patient.

Cúspide em garra é uma anomalia dental do desenvolvimento relativamente rara caracterizada por uma estrutura acessória em forma de cúspide projetando-se da área do cíngulo ou junção amelocementária. Ela é frequentemente encontrada na face palatina dos dentes maxilares anteriores na dentição permanente. A etiologia é controversa, mas é sugerido que essa condição tem causa multifatorial, incluindo ambos os fatores, genéticos e ambientais. Radiograficamente cúspides em garra são estruturas radiopacas, nas quais o esmalte, dentina e ocasionalmente a polpa podem ser vistos. A alteração é geralmente assintomática, mas pode causar problemas clínicos eventualmente. O diagnóstico precoce é importante para prevenir interferência oclusal, irritação na língua, necrose pulpar, cáries e alteração periodontal. O manejo clínico das cúspides em garra pode ser tanto conservativo quanto radical, dependendo do tamanho e forma do dente afetado. Nós relatamos um raro caso de cúspides em garra envolvendo todos os 6 dentes maxilares anteriores em um paciente de 20 anos de idade.

Cryosurgery as an Effective Alternative for Treatment of Oral Lesions in Children

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

As crianças podem apresentam uma grande variedade de patologias bucais, como lesões da mucosa oral, lesões ósseas, tumores, cistos e lesões cutâneas. Diferentes técnicas têm sido descritas para o tratamento destas lesões, mas todas elas são invasivas. O objetivo deste trabalho é relatar, por meio de uma revisão de literatura e apresentar clinicamente a eficácia da criocirurgia como alternativa para tratamentos cirúrgicos não invasivos das lesões bucais mais comuns em crianças. Esta técnica tem sido bem tolerada por pacientes pela ausência de anestesia, hemorragia mínima e rápida cicatrização. A crioterapia tem muitas aplicações na medicina oral e é uma alternativa extremamente útil em pacientes nos quais a cirurgia é contra-indicada devido a idade ou história médica. É uma técnica simples de se executar, minimamente invasiva, barata e muito efetiva na clinica de odontopediatria.

Liquid nitrogen cryosurgery for treatment of mucoceles in children.

A mucocele is a common benign lesion of the minor salivary gland mucosa that most frequently affects children and young adults. Several treatments have been described in the literature, including liquid nitrogen cryosurgery--a therapeutic alternative for treating mucoceles in children that has many applications in clinical oral pathology. The purpose of this paper was to present the treatment of lower lip mucoceles in 2 children via liquid nitrogen cryosurgery performed without local anesthesia. Also discussed are the mechanisms of action, current protocol of cryosurgery recommended in the management of mucoceles, clinical advantages and disadvantages, clinical outcomes, and pediatric patients' safety.

Recurrent oral pyogenic granuloma in port-wine stain.

Pyogenic granuloma (PG) is a benign inflammatory lesion, nonneoplastic in nature, which occurs in the oral cavity and skin. This lesion arises in response to various stimuli such as low-grade local irritations, traumatic injury, or hormonal factors. Recently, in some cases, the occurrence of recurrent PGs in skin associated with vascular lesions, such as port-wine stains, has been described. It has been postulated that this association is promoted by arteriovenous anastomoses in the vascular lesions, leading to the development of PG. The authors discuss 2 cases of recurrent PG in patients with a port-wine stain, and the treatment options adopted.

Metastatic adenocarcinoma of the colon: early manifestation in gingival tissue.

A case of gingival metastasis of adenocarcinoma of the colon is reported, the lesion being an early clinical indication of a primary malignant tumor. The diagnosis of metastatic lesion in the oral region is always challenging, both to clinician and to the pathologist, due to its rarity and complexity. In the present case, the clinical hypothesis was peripheral ossifying fibroma or pyogenic granuloma. Histologically, the biopsy tissue revealed a malignant neoplasm not connected to the mucosal surface. Immunohistochemically, the lesion was positive for 35ßH11 and cytokeratin 20 and focally positive for cytokeratin 7. Treatment involved excision of primary tumor and follow-up chemotherapy. The clinical, histological and immunohistochemical characteristics are discussed.

Gardner syndrome with no clinical family history.

Gardner syndrome, a variant of familial adenomatous polyposis, is a hereditary disorder inherited as an autosomal dominant with high penetrance and variable expression that is caused by a mutation of the adenomatous polyposis coli gene. It is characterized by gastrointestinal polyps associated with multiple osteomas, dental anomalies, skin and soft tissue tumors, and congenital hypertrophy of the retinal pigment epithelium. Early diagnosis of Gardner syndrome is crucial and may be life saving because the polyps usually undergo malignant change by the fourth decade of life. The extraintestinal manifestations frequently precede gastrointestinal symptoms; consequently, the dentist may play an important role in the diagnosis of this syndrome. The authors report a case of Gardner syndrome with no clinical family history that was diagnosed by the dentist based on oral and maxillofacial findings.