Reconstructive surgery and adjuvant radiotherapy for the multimodal approach in oral cancer: a single cancer centre experience.

Introduction and importance: Ablative surgery for oral cancer, irrespective of the histological subtype, causes large tissue defects, functional and aesthetic damage. Microsurgical free flaps have been widely used in reconstruction after resection, with satisfactory success rates in conjunction with adjuvant radiotherapy (RT). This study aims to describe our clinical institutional experience based on the multimodal treatment performed in four cases diagnosed with oral squamous cell carcinoma with the use of different microvascular free flaps and RT. Case series presentation: Four patients underwent reconstructive microsurgery after surgical resection of oral cancer, using three types of free flap: radial forearm fasciocutaneous, osteomyocutaneous fibular, and anterolateral thigh musculocutaneous flaps; RT was performed in Case 2 and Case 3. In the period of 3 years after microsurgical reconstruction and RT, flaps remain clinically stable without failure signs in full patients submitted to multimodal treatment. Clinical discussion: After resection of oral carcinomas, extensive tissue defects can be successfully treated with reconstructive microsurgery using different types of microvascular free flaps. RT for locoregional control is a feasible option and did not seem to interfere with the survival of flaps. Conclusion: An enhance long-term follow-up to assess overall and disease-free survival rates and quality of life must be carried out; however, cohort studies would be necessary for better understanding of the role of each treatment in the multimodal scheme.

An Atypical Bilateral Presentation of Fibrous Dysplasia (FD) in the Mandible: Clinical, imaging and therapeutic characterization.

INTRODUCTION AND IMPORTANCE: Fibrous Dysplasia (FD) is a benign fibro-osseous lesion, characterized by replacement with fibrous connective tissue instead of normal bone. The best treatment option for the condition has not yet been established, although several therapeutic approaches have been reported. The present case report describes the clinical, imaging and therapeutic aspects of an atypical bilateral presentation of FD in the mandible. CASE PRESENTATION: A 26-year-old afro-descendent woman, who had previously undergone surgery to remove FD in the right hemimandible, complained of asymptomatic swelling in the left hemimandible. Imaging analysis showed an ipsilateral extensive multilocular mandibular lesion, with thinning of the cortical bone. After diagnosis of FD, complete surgical removal was performed, associated with immediate local reconstruction with xenograft and covering membrane, with primary wound closure. CLINICAL DISCUSSION: Bilateral presentation of FD is uncommon, and its diagnosis by means of clinical data, imaging and histopathological analysis, is relevant in order to establish the correct therapy. CONCLUSION: Complete surgical removal associated with immediate local bone reconstruction, has shown satisfactory clinical results, when adequate follow-up is performed.

An atypical presentation of gigantiform torus palatinus: A case report: Atypical tori palatine and surgical management.

INTRODUCTION: Torus palatinus (TP) is a slow growing maxillary exostosis, commonly found in the in the hard palate on either side of the median raphe of the palatine bone. Its aetiology is still unclear, but it has been attributed to genetic events and environmental agents, with a slight predilection for the female gender. PRESENTATION OF CASE: The aim of this case report was to describe an unusual presentation of nodular TP in younger female patient, with medical history of hysterectomy when she was 25 years old. The TP manifested insidious progression that affected functional activities such as eating, swallowing and normal pronunciation. Furthermore, we describe our experience during pre-planning the surgery by using 3D-scan-printing, and the conservative surgical approach performed. DISCUSSION/CONCLUSION: TP may be associated with epidemiological, environmental and systemic disorders of patients suffering from this condition. Conservative surgical removal continues to be the first choice treatment when the TP must be removed. Further studies are considered necessary to elucidate the etiological factors.

Conservative management of odontogenic keratocyst with long-term 5-year follow-up: Case report and literature review.

INTRODUCTION: Odontogenic Keratocyst (OKC) is a benign lesion recently considered an odontogenic cyst in the present World Health Organization (WHO) classification of Head and Neck tumors (2017) mainly based on its clinical and histopathological features. Several studies, systematic reviews and meta-analyses have shown a multimodal approach to reducing the high recurrence rates inherently exhibited by this pathological condition after long-term periods of follow-up. PRESENTATION OF CASE: The patient, a 67-years-old woman, was submitted to conservative surgical management of an odontogenic keratocyst. Initially this consisted of decompression and subsequent enucleation, with a long-term period of follow-up to ensure that there was no recurrence. DISCUSSION: Conservative surgical management is the first choice and might be considered the gold standard, but combined therapy such as marsupialization, application of Carnoy's solution, enucleation of the remnant lesion and an extensive follow-up period would considerably reduce recurrence rates. CONCLUSION: Therefore, an appropriate long-term follow-up must be done after the treatment performed in order to ensure clinical success, which in this case was described as an absence of signs of recurrent disease.

Is low-level laser therapy (LLLT) effective in relieving the symptoms of temporomandibular disorders (TMDs)? A systematic review / ¿La terapia láser de bajo nivel (LLLT) es eficaz para aliviar los síntomas de los trastornos temporomandibulares (TTM)? Revisión sistemática

ABSTRACT Introduction: LLLT is used in various clinical situations for the relief of postoperative inflammatory symptoms in TMD cases. Many treatment protocols use laser radiation, but there is still no evidence as to whether one of them is superior to all the other. The objective was to establish whether there is evidence that LLLT can reduce the main symptoms of TMDs and to determine the most effective application protocol. Methods: a systematic review of the literature was performed in the main databases: PubMed, Scopus and Web of Science, by independent researchers who evaluated studies using different LLLT protocols to treat TMD symptoms, considering specific outcomes such as pain, mouth opening and jaw movements. Results: thirteen studies fully met the eligibility criteria. The most used laser type was GaAlAg, with a wavelength of 830 nm, number of applications ranging from 8 to 10, and 4 weeks of follow-up. Conclusions: LLLT may be considered as an alternative for the relief of TMD symptoms; however, scientific evidence of one of the protocols being superior to the others could not be found.

RESUMEN Introducción: la terapia láser de bajo nivel (LLLT por sus iniciales en inglés) se utiliza en diversas situaciones clínicas para el alivio de los síntomas inflamatorios posoperatorios en casos de trastornos temporomandibulares (TTM). Hay muchos protocolos de tratamiento que utilizan radiación láser, pero todavía no hay evidencia de que alguno sea superior a los demás. El objetivo de la presente revisión sistemática consistió en determiner si hay evidencia de que la LLLT pueda reducir los principales síntomas de los TTM y determinar el protocol de aplicación más eficaz. Métodos: se realizó una revisión sistemática de la literatura en las principales bases de datos, PubMed, Scopus y Web of Science, por parte de investigadores independientes que evaluaron los estudios utilizando diferentes protocolos de LLLT para tratar los síntomas de los TTM, considerando resultados específicos como dolor, apertura de la boca y movimientos de la mandíbula. Resultados: trece estudios cumplieron plenamente los criterios de elegibilidad. El tipo de láser más utilizado fue GaAlAg, con una longitud de onda de 830 nm, número de aplicaciones que oscilan entre 8 y 10, y 4 semanas de seguimiento. Conclusiones: la LLLT puede considerarse una alternativa para el alivio de los síntomas de los TTM; sin embargo, no se pudo encontrar evidencia científica de que un protocolo sea superior a los demás.

Avaliação da eficácia da fotobiomodulação na remodelação do osso alveolar humano por meio das análises microtomográfica e histológica / The effect of photobiomodulation therapy on human alveolar bone repair using microtomography and histologic evaluations

A remodelação do processo alveolar após a exodontia é um fenômeno fisiológico que resulta em alterações das dimensões ósseas e que podem interferir na reabilitação protética. Para minimizar a perda óssea, estratégias de preservação do rebordo vêm sendo empregadas e a terapia por fotobiomodulação (TFBM) se destaca como uma opção de baixo custo e morbidade. Estudos prévios evidenciaram o impacto positivo da TFBM no reparo ósseo. O objetivo do presente trabalho foi avaliar o efeito TFBM no reparo alveolar. Vinte pacientes com indicação clínica de exodontia dos primeiros ou segundos molares bilateralmente foram selecionados e os lados direito e esquerdo de cada paciente distribuídos em um dos grupos experimentais: (1) TFBM, tratado com laser de baixa frequência, e (2) Controle, que recebeu o mesmo tratamento com o equipamento desligado; a aplicação foi realizada no pós-operatório imediato, 1, 2, 3, 4, 7 e 15 dias. Aos 45 dias pós-exodontia, espécimes de tecido do interior dos alvéolos foram coletados para análise microtomográfica e histológica. Os dados foram comparados utilizando o Teste-t pareado e o nível de significância foi de 5%. A análise morfométrica evidenciou diferenças estatisticamente significante entre os grupos para os seguintes parâmetros: superfície óssea (p=0,029), superfície óssea/volume total (p=0,028), número de trabéculas (p=0,025) e densidade de conectividade (p=0,029), maiores no grupo TFBM em relação ao Controle. O volume ósseo, volume ósseo/total, espessura e separação trabecular não apresentaram diferenças estatisticamente significantes (p=0,054; p=0,082; p=0,598 e p=0,109, respectivamente). Esses dados foram confirmados na análise histológica, onde foi identificado maior quantidade de tecido trabecular no grupo TFBM, enquanto no Controle fica evidente maior quantidade de tecido conjuntivo. Os resultados evidenciaram que a terapia de fotobiomodulação tem efeito positivo no reparo de alvéolos humanos.

Anomalìas radiculares

Las anomalìas radiculares se presenta con cierta frecuencia en personas de cualquier ìndole sin distinciòn de sexo, edad, pieza dentaria o arcada dentaria, sin embargo estas alteraciones es necesario analizarlas y estudiarlas al momento de dar tratamientos odontològicos como endodoncias y exodoncias a los pacientes. Exponemos a continuaciòn las alteraciones radiculares màs frecuentes basadas en las complicaciones que se producen especialmente al realizar las evaluaciones de òrganos dentarios recopilados en el Subcentro de Salud Chiriyacu en 1996-1997, y de las cuales un 50 por ciento fueron causadas por anomalìas radiculares un 30 por ciento por tècnicas de extracciòn mal empleados y el 10 por ciento por enfermedades sistèmicas.

Anomalías radiculares

Las anomalías radiculares se presentan con cierta frecuencia en personas de cualquier índole sin distinción de sexo, edad, pieza dentaria o arcada dentaría, sin embargo estas alteraciones es necesario analizarlas y estudiarlas al momento de dar tratamientos odontológicos como endodoncias y exodoncias a los pacientes. Exponemos a continuación las alteraciones radiculares más frecuentes basadas en las complicaciones que se producen especialmente al realizar las avulciones de órganos dentarios recopilados en el Subcentro de Salud Cririyacu Alto en el año 1996 y 1997, y de las cuales un 50 por ciento fueron causadas por anomalías radiculares un 30 por ciento por técnicas de extracción mal empleados y el 10 por ciento por enfermedades sistémicas