Hemi-craneotomía y hemimandibulectomía izquierda como tratamiento del ameloblastoma multiquístico, manejo multidisciplinario. Reporte de caso / Left hemi-craneotomy and hemimandibulectomy as treatment of multicystic ameloblastoma, multidisciplinary management. Case report

El ameloblastoma multiquístico, una neoplasia odontogénica de crecimiento lento, pero comportamiento agresivo, suele manifestarse en la mandíbula, generando deformidades faciales, pérdida dentaria y desplazamiento de tejidos adyacentes. Este estudio tiene como objetivo describir el tratamiento quirúrgico multidisciplinario del ameloblastoma multiquístico en una localización inusual, destacando el compromiso de estructuras vitales y los estudios complementarios necesarios para un diagnóstico preciso. Se presenta el caso de un paciente masculino con una lesión en la hemicara izquierda, que se había desarrollado durante aproximadamente ocho meses, abarcando desde la región temporoparietal hasta la región maseterina ipsilateral. La evaluación clínica y radiológica inicial sugirió la posibilidad de un ameloblastoma multiquístico, confirmado posteriormente mediante biopsia. Como parte del equipo multidisciplinario del Hospital San Vicente Fundación de Medellín, se optó por una resección quirúrgica radical, que incluyó hemi-craneotomía y hemi-mandibulectomía, seguida de una reconstrucción exitosa. Se señala la importancia de un abordaje coordinado entre cirujanos maxilofaciales, estomatólogos y otros especialistas, así como la relevancia de los estudios complementarios para determinar el curso terapéutico óptimo. La cirugía reconstructiva demostró ser efectiva tanto en la restauración funcional como estética, aunque destaca los desafíos inherentes a la gestión de localizaciones poco comunes de esta enfermedad.

Multicystic ameloblastoma, a slow-growing but aggressive odontogenic neoplasm, usually manifests in the mandible, causing facial deformities, tooth loss and displacement of adjacent tissues. This study aims to describe the multidisciplinary surgical management of multicystic ameloblastoma in an unusual location, highlighting the involvement of vital structures and the complementary studies necessary for an accurate diagnosis. We present the case of a male patient with a lesion in the left hemiface, which had developed over approximately eight months, spanning from the temporoparietal region to the ipsilateral maseterine region. Initial clinical and radiological evaluation suggested the possibility of multicystic ameloblastoma, subsequently confirmed by biopsy. As part of the multidisciplinary team of the Hospital San Vicente Fundación de Medellín, a radical surgical resection was chosen, including hemi-craniotomy and hemi-mandibulectomy, followed by successful reconstruction. The importance of a coordinated approach between maxillofacial surgeons, stomatologists and other specialists is emphasized, as well as the relevance of complementary studies to determine the optimal therapeutic course. Reconstructive surgery proved to be effective in both functional and cosmetic restoration, although it highlights the challenges inherent in managing rare locations of this disease.

Tumor odontogénico adenomatoide. Reporte de un caso clínico / Adenomatoid odontogenic tumor. Clinical case report

El Tumor Odontogénico Adenomatoide (TOA) es una neoplasia benigna poco común, caracterizada por un crecimiento lento y progresivo, en la mayoría de los casos asintomático. Es una patología intraósea, que puede ser folicular o extrafolicular, siendo el tipo folicular el más común. Se presenta en hombres y mujeres, con predilección por el sexo femenino. Histológicamente está compuesto por epitelio odontogénico organizado en distintos patrones histoarquitectónicos, incrustado en un estroma de tejido fibroconectivo maduro. Se describe el caso clínico de una paciente femenina de 25 años, con aumento de volumen en la región maxilar anterior izquierda, que se extiende a la base de la nariz, produce desvío de la línea media a la derecha y tiene un año de evolución.

The Adenomatoid Odontogenic Tumor (AOT) is an uncommon benign neoplasm, characterized by slow and progressive growth, in most cases asymptomatic. It is an intraosseous pathology, which can be follicular or extrafollicular, with the follicular type being the most common. It occurs in both men and women, with a predilection for the female sex. Histologically, it is composed of odontogenic epithelium organized in different histoarchitectonic patterns, embedded in a stroma of mature fibroconnective tissue. We describe the clinical case of a 25-year-old female patient with increased volume in the left anterior maxillary region, extending to the base of the nose, causing deviation of the midline to the right and having one year of evolution.

Hepatocellular carcinoma metastasis to the mandible: a challenging diagnosis

Introduction: Metastasis of hepatocellular carcinoma (HCC) to the mandible is an extre-mely rare condition with less than a hundred cases reported worldwide. Such lesions do not have any pathognomonic clinical, radiologic, or histologic features, and they can mimic many other conditions or diseases with orofacial involvement. Case report: We present an interesting but intriguing case of metastasis of HCC to the mandible, which presented as an orofacial swelling accompanied by intense pain and spontaneous bleeding following tooth removal. Conclusion: This paper highlights the importance of integration of the in-depth medical history of the patient, clinical findings, and microscopic examinations in cases of uncommon oral lesions of challenging diagnosis. (AU)

Chondromyxoid fibroma affecting the maxilla in a 1-year-old child: Immunohistochemical analysis and literature review.

Chondromyxoid fibroma (CMF) is a benign chondroid/myxoid matrix-producing tumor that often develops in the long bones of young adults. CMF is rarely reported in the craniofacial skeleton, with most cases presenting with bone erosion or destruction, which may lead to a misdiagnosis. To date, approximately 129 cases of CMF in the craniofacial region have been reported, with only three cases in patients aged less than 1 year. Of these 129 cases, only 34 affected the jaws. A 1-year-old boy presented with a mass in the left anterior maxilla, extending and compressing the ipsilateral nasal cavity. After surgical excision of the lesion, microscopy revealed spindle-to-stellate tumor cells surrounded by a predominant myxoid stroma containing focal slit-like vascular channels and hemorrhagic areas. Immunohistochemistry showed positivity for vimentin, CD10, and α-SMA (focal). The Ki-67 labeling index was 6%. CFM should be included in the differential diagnosis when assessing maxillary tumors in pediatric patients.

Mixoma odontogênico de mandíbula tratado por curetagem, osteotomia periférica e uso de solução de carnoy: relato de caso mandibular / Odontogenic myxoma treated by curettage, peripheral osteotomy and uso of carnoy's solution: case report

O mixoma odontogênico é um tumor benigno que acomete os maxilares, de rara ocorrência que tem origem a partir do componente ectomesenquimatoso de um germe dentário, seja ao nível da papila dentária, ao nível do folículo ou ainda ao nível do ligamento periodontal. Tem predileção pelo sexo feminino, podendo comprometer com mais significância a faixa etária da segunda à quarta década de vida. O tratamento dos mixomas odontogênicos pode ser conservador ou radical. Com relação à escolha do tratamento, deve o cirurgião levar em consideração principalmente a extensão do envolvimento da lesão. O tratamento conservador pode ser considerado como primeira escolha, evitando efeitos associados a morbidade, comprometimento de estruturas anatômicas nobres e diminuição da qualidade de vida. Por se tratar de lesão recidivante, métodos complementares de tratamento têm sido empregados, tais como osteotomia periférica, uso do nitrogênio líquido e a solução de Carnoy. Este trabalho teve como objetivo relatar um caso de mixoma odontogênico em corpo mandibular de paciente do sexo feminino, leucoderma, 25 anos, solteira, natural de Recife-PE- Brasil, tratado de forma conservadora através de curetagem, osteotomia periférica e uso de solução de Carnoy, que até o presente momento não ocorreu sinais de recidiva... (AU)

Odontogenic myxoma is a rare benign tumor that affects the jaws. It´s originates from the ectomesenchymatous component of a dental germ, either at the level of the dental papilla, at the level of the follicle or at the level of the periodontal ligament. It has a predilection for the female sex, being able to compromise with more significance the age group from the 2nd to the 4th. decade of life. The treatment of odontogenic myxomas can be conservative or radical. Regarding the choice of treatment, the surgeon must take into account mainly the extent of the lesion's involvement. Conservative treatment can be considered as the first choice, avoiding effects associated with morbidity, impairment of noble anatomical structures and decreased quality of life. As it is a recurrent lesion, complementary treatment methods have been used, such as peripheral osteotomy, use of liquid nitrogen and Carnoy's solution. This study aimed to report a case of odontogenic myxoma in the mandibular body of a female patient, leucoderma, 25 years old, single, born in Recife-PE- Brazil, treated conservatively through curettage, peripheral osteotomy and use of a solution of Carnoy, that until now there have been no signs of recurrence... (AU)

Retinal ischemia following mandible tumor treatment with steroid injection / Isquemia de retina após tratamento de tumor de mandíbula com injeção de esteroide

ABSTRACT Central giant cell granuloma is a rare osseous tumor affecting young patients with anatomical and functional compromise of the maxilla and mandible. Steroid injection therapy constitutes a less invasive treatment modality for disease control in selected cases. Retinal ischemia is a reported complication of multiple medical procedures, including dental interventions, and may lead to loss of vision with poor prognosis. We report a case of retinal arteriolar ischemic disease following central giant cell granuloma management with local injected corticosteroids.

RESUMO O granuloma central de células gigantes é um tumor ósseo raro que afeta pacientes jovens com comprometimento anatômico e funcional da maxila e mandíbula. A terapia com injeção de esteroides constitui uma modalidade de tratamento menos invasiva para o controle da doença em casos selecionados. A isquemia retiniana é uma complicação relatada em vários procedimentos médicos, incluindo intervenções odontológicas, e pode levar à perda da visão com mau prognóstico. Relatamos um caso de doença isquêmica arteriolar da retina após o tratamento com granuloma central de células gigantes com corticosteroides injetados locais.

Juvenile ossifying fibroma: series of seven cases focusing on clinical and pathological aspects / Fibroma ossificante juvenil: série de sete casos com enfoque nos aspectos clinicopatológicos

ABSTRACT Juvenile ossifying fibroma (JOF) is an uncommon benign fibro-osseous lesion that affects young individuals and deserves attention because it presents an aggressive clinical behavior and high rates of recurrence. This paper aims to report seven cases diagnosed as JOF - age ranging from 11 to 39 years - in a referral center, correlating our findings with clinical and pathological aspects in the literature. The mandible was the most common location, and in three cases, painful symptoms were reported. Regarding the histopathological findings, the majority of cases exhibited a cellularized pattern, and the trabecular subtype was the most commonly found. Regarding treatment, three cases relapsed, and, in two of them, conservative treatments were performed. Accordingly, knowing the clinical-pathological aspects of JOF is important for the correct diagnosis and the establishment of an appropriate treatment that decreases the high recurrence rate of this lesion.

RESUMEN El fibroma osificante juvenil (FOJ) es una lesión fibro-ósea benigna pocofrecuente que acomete personasjóvenesy merece realce, puespresenta comportamiento clínico agresivo y altas tasas de recidivas. Reportamos siete casos diagnosticados como FOJ - con pacientes entre 11 y 39 anos de edad - en un centro de referencia, relacionando nuestros hallazgos con los aspectos clínicos y patológicos existentes en la literatura. La mandíbula fue la ubicación más común; en tres casos se reportaron síntomas dolorosos. En lo que respecta a los hallazgos histopatológicos, la mayor parte de los casos se mostró altamente celularizada, siendo el subtipo trabecular el más común. En cuanto al tratamiento, de los tres casos que presentaran recurrencia, en dos se realizaron tratamientos conservadores. Ante eso, se resalta la importancia de conocer los aspectos clínicos y patológicos del FOJ para hacer el diagnóstico preciso y establecer un tratamiento adecuado que reduzca el alto índice de recidivas de esa lesión.

RESUMO O fibroma ossificante juvenil (FOJ) é uma lesão fibro-óssea benigna incomum que acomete indivíduos jovens e merece destaque por apresentar um comportamento clínico agressivo e altas taxas de recidivas. Este trabalho tem como objetivo relatar sete casos diagnosticados como FOJ - com variação de idade entre 11 e 39 anos - em um centro de referência, correlacionando nossos achados com os aspectos clinicopatológicos existentes na literatura. A mandíbula foi a localização mais comum; em três casos foi relatada sintomatologia dolorosa. Com relação aos achados histopatológicos, a maioria dos casos exibiu um padrão bem celularizado, sendo o subtipo trabecular o mais encontrado. No que diz respeito ao tratamento, dos três casos que apresentaram recidiva, em dois, foram realizados tratamentos conservadores. Diante disso, ressalta-se a importância do conhecimento dos aspectos clínicos epatológicos do FOJ para a realização de um diagnóstico correto e o estabelecimento de um tratamento adequado que diminua o alto índice de recidivas dessa lesão.

Calcifying epithelial odontogenic tumours: Collaborative study of 32 cases and review of literature.

OBJECTIVES: To analyse the occurrence of calcifying epithelial odontogenic tumours (CEOT) based on biopsy records from different Brazilian geographic regions and to contrast the data with a review of the literature. MATERIALS AND METHODS: A 2-step study was conducted. Step 1 consisted of a collaborative study of biopsies obtained from 1953 to 2017 at six Brazilian oral and maxillofacial pathology centres. Evaluation of 86,268 biopsy records was performed. Demographic and histopathological diagnosis data were assessed. In Step 2, a review of the literature of case reports and cases series of CEOT identified across five electronic databases was conducted. RESULTS: In the collaborative study, 32 cases of CEOT were evaluated. This figure represented 0.03% of the oral and maxillofacial lesions and 1.7% of all odontogenic tumours across the centres. Women in the fourth decade of life were more affected. CEOT occurred more in the mandible than in the maxilla (ratio 1.9:1). The review of the literature showed that Asian individuals were more affected by this neoplasm. CONCLUSIONS: Useful knowledge on the epidemiology, treatment and follow-up of CEOT has been provided. Demographic data and clinical features of the cases presented in this collaborative study were quite similar to those of studies reported worldwide.

Caso inusual de un ameloblastoma uniquístico en paciente pediátrico / Unusual case of unicystic ameloblastoma in pediatric patient

El ameloblastoma a pesar de ser un tumor benigno es uno de los más agresivos y destructivos localmente de la región maxilofacial, siendo capaz de generar grandes deformaciones faciales en un corto lapso de tiempo, creciendo dentro del hueso sin perforarlo. La variante uniquística, por ser considerada la menos agresiva, permite un manejo conservador de esta patología. No es frecuente en niños y los criterios de tratamiento quirúrgico en la infancia son controversiales, debido, en parte, al riesgo de recurrencia cuando se practican métodos conservadores. Se presenta un caso inusual de ameloblastoma uniquístico localizado en la región anterior del maxilar inferior. Este tipo de lesiones se presenta mayormente en adultos jóvenes, principalmente en la segunda década de vida y en este caso se presentó en una niña de 12 años. La lesión fue manejada de manera conservadora con un seguimiento de cuatro años, siendo que esta no presentó recidiva.

Ameloblastoma is one of the most aggressive and destructive benign tumors locally in the maxillofacial region, it is able to generate large facial deformations in a short period. Within its classification, the unicystic variant is considered the least aggressive and allows a conservative management of this pathology. It is not frequent in children and the criteria for surgical treatment in childhood are controversial, due to the risk of recurrence when practicing conservative methods. An unusual case of unicystic ameloblastoma is located in the anterior region of the lower jaw. This type of lesions occurs mainly in young adults, mainly in the second decade of life and in this case, was presented in a 12-year old girl. The lesion was managed conservatively with a follow-up of four years, since it did not present a recurrence.

Ameloblastoma multiquístico de crecimiento rápido con reconstrucción parcial / Multicystic ameloblastoma of fast growing with partial reconstruction

Introducción: El ameloblastoma es una neoplasia benigna, que tiende a ser localmente agresiva, con gran tendencia a la recidiva. Es un tumor odontogénico de origen epitelial; el 80 por ciento de los casos se presenta a nivel mandibular, tanto en rama como en ángulo. Suele manifestarse durante la tercera a quinta décadas de la vida. Las características clínicas no son determinantes del comportamiento biológico y tampoco del pronóstico de un ameloblastoma, ni siquiera en muchos de los casos en los que se complementan con radiografías y/o muestras histopatológicas. Objetivo: Informar el manejo quirúrgico del ameloblastoma multiquístico de manera radical a través de una resección amplia y colocación de placa de reconstrucción que funcionó como mantenedor de espacio, debido a su inusual crecimiento rápido. Presentación de l caso: Se describe un caso clínico de un paciente de sexo masculino, quien presenta una lesión tumoral en rama mandibular derecha, con aspecto clínico de un ameloblastoma de tipo folicular, multiquístico, de crecimiento rápido, tratado en el Hospital Universitario del Caribe de Cartagena, Colombia. Se proporcionan datos sobre su aparición clínica como su rápida evolución, los hallazgos histopatológicos y el manejo terapéutico realizado. Conclusiones: Debido a su crecimiento rápido, para este caso en particular, la opción más factible fue llevar a cabo la resección total de la lesión con el objetivo de evitar o disminuir la posibilidad de recidiva, seguido de reconstrucción con placa de osteosíntesis para devolverle la funcionalidad a la articulación temporomandibular y al hueso mandibular, sin dejar a un lado la estética del paciente(AU)

Introduction: Ameloblastoma is a benign neoplasm that tends to be locally aggressive, with a high tendency to relapse. It is an odontogenic tumor of epithelial origin; 80 percent of cases occur at the mandibular level, both in branch and at an angle. It usually manifests during the third to fifth decade of life. The clinical characteristics are not determinants for the biological behavior or the prognosis of an ameloblastoma, even in many of the cases in which they are complemented with radiographs and/or histopathological samples. Objective: To report the surgical management of multicystic ameloblastoma in a radical way through a wide resection and placement of a reconstruction plate that functioned as a space maintainer, due to its unusual rapid growth. Case presentation: A clinical case of a male patient is described, who presents a tumor lesion in the right mandibular branch, with a clinical appearance of a multicystic, fast growing, follicular ameloblastoma, treated at Hospital Universitario del Caribe in Cartagena, Colombia. Data were provided on its clinical appearance, its rapid evolution, the histopathological findings and the therapeutic management performed. Conclusions: Due to its rapid growth, for this particular case, the most feasible option was to carry out the total resection of the lesion in order to avoid or reduce the possibility of relapse, followed by reconstruction with an osteosynthesis plate to restore the functionality of the temporomandibular joint and of the mandibular bone, without leaving aside the aesthetics of the patient(AU)

Ameloblastoma multiquístico de crecimiento rápido con reconstrucción parcial / Multicystic ameloblastoma of fast growing with partial reconstruction

Introducción: El ameloblastoma es una neoplasia benigna, que tiende a ser localmente agresiva, con gran tendencia a la recidiva. Es un tumor odontogénico de origen epitelial; el 80 por ciento de los casos se presenta a nivel mandibular, tanto en rama como en ángulo. Suele manifestarse durante la tercera a quinta décadas de la vida. Las características clínicas no son determinantes del comportamiento biológico y tampoco del pronóstico de un ameloblastoma, ni siquiera en muchos de los casos en los que se complementan con radiografías y/o muestras histopatológicas. Objetivo: Informar el manejo quirúrgico del ameloblastoma multiquístico de manera radical a través de una resección amplia y colocación de placa de reconstrucción que funcionó como mantenedor de espacio, debido a su inusual crecimiento rápido. Presentación de l caso: Se describe un caso clínico de un paciente de sexo masculino, quien presenta una lesión tumoral en rama mandibular derecha, con aspecto clínico de un ameloblastoma de tipo folicular, multiquístico, de crecimiento rápido, tratado en el Hospital Universitario del Caribe de Cartagena, Colombia. Se proporcionan datos sobre su aparición clínica como su rápida evolución, los hallazgos histopatológicos y el manejo terapéutico realizado. Conclusiones: Debido a su crecimiento rápido, para este caso en particular, la opción más factible fue llevar a cabo la resección total de la lesión con el objetivo de evitar o disminuir la posibilidad de recidiva, seguido de reconstrucción con placa de osteosíntesis para devolverle la funcionalidad a la articulación temporomandibular y al hueso mandibular, sin dejar a un lado la estética del paciente(AU)

Introduction: Ameloblastoma is a benign neoplasm that tends to be locally aggressive, with a high tendency to relapse. It is an odontogenic tumor of epithelial origin; 80 percent of cases occur at the mandibular level, both in branch and at an angle. It usually manifests during the third to fifth decade of life. The clinical characteristics are not determinants for the biological behavior or the prognosis of an ameloblastoma, even in many of the cases in which they are complemented with radiographs and/or histopathological samples. Objective: To report the surgical management of multicystic ameloblastoma in a radical way through a wide resection and placement of a reconstruction plate that functioned as a space maintainer, due to its unusual rapid growth. Case presentation: A clinical case of a male patient is described, who presents a tumor lesion in the right mandibular branch, with a clinical appearance of a multicystic, fast growing, follicular ameloblastoma, treated at Hospital Universitario del Caribe in Cartagena, Colombia. Data were provided on its clinical appearance, its rapid evolution, the histopathological findings and the therapeutic management performed. Conclusions: Due to its rapid growth, for this particular case, the most feasible option was to carry out the total resection of the lesion in order to avoid or reduce the possibility of relapse, followed by reconstruction with an osteosynthesis plate to restore the functionality of the temporomandibular joint and of the mandibular bone, without leaving aside the aesthetics of the patient(AU)

Cáncer Bucomaxilofacial en Niños III: Tumores Malignos del Tejido Blando / Oral and Maxillofacial Cancer in Children III: Malignant Soft Tissue Tumors

RESUMEN: El grupo de neoplasias malignas de tejido blando de la región de cabeza y cuello en pacientes pediátricos está representado por carcinomas, sarcomas, melanomas y tumores de diferenciación incierta. La neoplasia más prevalente en la población pediátrica es el Rabdomiosarcoma, seguido por el carcinoma de células escamosas. Los rangos de presentación son muy amplios, siendo los grupos entre 2-6 años y 15-19 años los que presentan mayor incidencia. Se ha planteado que la etiología de estas neoplasias es incierta. El tratamiento de estas neoplasias es comúnmente de enfoque multimodal, combinando un procedimiento quirúrgico con quimioterapia y radioterapia. El pronóstico y sobrevida del paciente dependerán principalmente del momento en que se realice el diagnóstico de la lesión. Un diagnóstico y tratamiento temprano favorecen las posibilidades de sobrevida y el pronóstico del paciente. Este estudio corresponde a la 3ra parte de "Cáncer bucomaxilofacial en niños". Se hará referencia a los distintos tumores malignos del tejido blando en la población pediátrica en el territorio de cabeza y cuello, abarcando sus generalidades, etiología, epidemiología, tratamiento y pronóstico.

ABSTRACT: Head and neck malignant tumors in pediatric patients comprise carcinoma, sarcoma, melanoma and tumours of uncertain differentiation. Within the pediatric population, the most prevalent neoplasm is rhabdomyosarcoma, followed by squamous cell carcinoma. There is a wide range in the presentation, and it varies significantly with age groups of 2-6 and 15-19 year-olds who present the higher incidence rates. For this reason, it has been suggested that the etiology of head and neck neoplasms remains unclear. Treating these pathologies usually involves a multimodal approach that combines surgery, radiation and chemotherapy. Prognosis and survival rates depend mainly of the stage at the time of diagnosis. Early diagnosis and treatment can improve prognosis and survival rates. In this 3rd part of "Maxillofacial Cancer in Pediatric Patients", we studied a variety of malignant tumors in head and neck soft tissue from a paediatric sample. Specifically, we aim to analyze their etiology, epidemiology, treatment and prognosis.

Manejo quirúrgico de tumor mandibular asistido con la tecnología de impresión tridimensional: nota técnica y reporte de caso / Surgical management of mandible tumor assisted with three-dimensional printing technology: a technical note and case report

Objetivo: Introducir la tecnología de impresión tridimensional para la creación de modelos anatómicos para asistir la planificación quirúrgica de tumores mandibulares. Caso clínico: Presentamos el caso de una paciente de 30 años con historial de tumoración en la mandíbula, sector anterior, con 2 años de evolución. La biopsia incisional confirmó que se trataba de un fibroma osificante. Con la asistencia de la tecnología de impresión tridimensional se realizó la planificación quirúrgica para establecer los márgenes de osteotomías y el predoblado de la placa de reconstrucción. Adicionalmente se describe en detalle el proceso de construcción del modelo de prototipado rápido con la tecnología de impresión tridimensional.

Aim: Introduction of three-dimensional printing technology for the generation of medical rapid prototyping models, an assistant tool in surgical planning of mandibular tumors. Clinical case: We report the case of a 30-years-old female patient who presented an anterior mandible mass with 2 years of evolution. Incisional biopsy confirmed ossifying fibroma. With the assistance of three-dimensional printing technology, 3D model was created and surgical planning was performed with the design of osteotomy sites for mandibular resection. Furthermore, prebending of reconstruction plate based on 3D model was accomplished. The protocol for rapid prototyping models creation in details is described in this article.

Use of refrigerant spray of a propane/butane/isobutane gas mixture in the management of keratocystic odontogenic tumors: a preliminary study.

PURPOSE: Keratocystic odontogenic tumor (KCOT) is an aggressive benign tumor and the management by complete enucleation followed by cryotherapy maintains the inorganic bone matrix, resulting in better repair and reduces the rates of recurrence. A refrigerant spray with a propane/butane/isobutane gas mixture has been pointed to as an alternative to liquid nitrogen, because the device is easy to handle and contain within the cavity, providing better control and lower risk of injury to the adjacent soft tissue. Thus, the aim of this study was to evaluate the outcome of enucleation followed by cryosurgery using a refrigerant spray of this gas mixture in ten patients diagnosed with KCOT. METHOD: The biggest lesions received a prior treatment consisting of marsupialization to decrease the tumor size. During the surgeries, the lesions were removed by enucleation and the surgical site was sprayed with the gas mixture. RESULTS: Wound dehiscence was observed in all cases, which healed by the second intention. The mean follow-up period was 64.3 months (range 24-120 months). Eight of the ten patients showed no evidence of clinical or radiographic recurrence. Pathologic fractures and infections were not observed. CONCLUSIONS: The results obtained suggest that enucleation followed by cryosurgery is an effective therapy for managing KCOT.

Análise por Elementos Finitos das Forças Mastigatórias em uma Placa de Reconstrução Mandibular / Assessment of masticatory forces in a mandibular reconstruction titanium plate through finite element analysis

Ressecção cirúrgica é um tratamento radical de algumas patologias que acometem a mandíbula e suas estruturas associadas. A técnica baseia-se na remoção total da lesão com uma margem de segurança em toda a sua dimensão, podendo ser ela marginal ou parcial. A escolha dá-se pela proximidade da extensão da lesão com a margem inferior da mandíbula. Em situações de ressecção mandibular parcial, remove-se parcialmente a margem inferior da mandíbula o que, posteriormente, dificulta a reobtenção da estética e funcionalidade do aparelho estomatognático, sendo a área reconstruída com uma placa de reconstrução óssea. A análise de elementos finitos (AEF) é uma forma de análise matemática, que se fundamenta na divisão de uma estrutura em um número finito de pequenas áreas, denominado de elementos finitos. A essa divisão dá se o nome de "malha". Em geral, a AEF possui a capacidade de modelar matematicamente estruturas, tornando-se possível a aplicação de forças em qualquer ponto e/ou direção. Dessa forma, conseguem-se dados sobre a deformação e o grau de tensão inicial, sendo possível, assim, representar situações in vivo, expressando condições compatíveis com o real. O trabalho visa analisar e simular as tensões geradas pelas forças mastigatórias, com o uso de elementos finitos, em simulação de uma mandíbula reconstruída com placa e parafusos de titânio, após sua ressecção parcial... (AU)

Surgical ressection is a radical treatment of some pathologies that affect the mandible and its structures. The technique is based on total removal of the lesion with a safe margin in all extension of the bone. Partial mandible resection results in a difficult to obtain the aesthetic and functionality of the stomatognathic system. In such cases, is recommended a titanium plate commonly used to mandibular reconstruction. Finite Element Analysis (FEA) is a form of math analysis which is based on division of a structure in a finite number of small areas. In general, FEA has the ability to mathematically model structures making possible applying forces in any point and/ or direction. Thereby, it can bring forth datas of displacement and tension being possible representing in vivo situation. This study aims to analyze and simulate the tensions generated by the masticatory forces, using FEA in a mandibular reconstruction with titanium plate after partial resection... (AU)

Management of locally aggressive mandibular tumours using a gas combination cryosurgery.

This study evaluated the results of curettage followed by cryosurgery using a combination of propane, butane, and isobutane gas for several benign but locally aggressive bone tumours on the mandible. Twenty-nine patients (16 men and 13 women) participated in the study. Patient ages ranged from 6 to 87 years (mean, 23.72 years). Before enucleation and cryosurgery, some patients received prior treatment consisting of marsupialisation to decrease tumour size. Twenty-seven of the 29 patients (93.10%) showed no evidence of clinical or radiographic recurrence after treatment through enucleation and cryosurgery. Wound dehiscence, which was observed in all cases, healed by second intention. The average follow-up period was 70.55 months (range, 53-120 months). These results suggest that enucleation followed by cryosurgery is an effective therapy for managing locally aggressive mandible tumours. In addition, this treatment is a less expensive intervention than more radical procedures.

Reconstrução mandibular com prótese de resina acrílica após ressecção de ameloblastoma. Relato de caso e avaliação da qualidade de vida / Mandibular reconstruction with an acrylic resin prosthesis after resection of an ameloblastoma: a case report and review of quality of life

O ameloblastoma multicístico é uma lesão de origem odontogênica, que acomete, principalmente, pacientes entre a terceira e a quinta década de vida. Apesar de ser um tumor benigno, muitas vezes, apresenta-se com comportamento agressivo, o que pode exigir intervenções terapêuticas radicais. Casos de ressecções extensas podem representar a perda de uma grande porção de segmento ósseo, produzindo graves sequelas estéticas e funcionais, além da diminuição da qualidade de vida do doente. A reconstrução mandibular representa um importante estágio na reabilitação de pacientes submetidos à exérese de tumores extensos. A utilização de próteses de titânio se traduz numa alternativa confiável, mas ainda inacessível à grande maioria dos pacientes devido ao seu alto custo. Para tanto, o estudo de materiais alternativos viáveis se faz necessário. Nosso trabalho apresenta o caso de um paciente do sexo masculino, 56 anos, que compareceu ao ambulatório de CTBMF do Hospital da Restauração, com queixa de dor e aumento de volume em hemiface direita há mais ou menos dois anos, sendo submetido à hemimandibulectomia após firmado diagnóstico de ameloblastoma musticístico e reabilitação imediata feita por prótese personalizada, confeccionada em resina acrílica. As necessidades do paciente percebidas e o ganho em qualidade de vida foram analisados antes e após o tratamento por meio da aplicação do questionário "perfil de impacto de saúde bucal" (Oral Health Impact Profile - OHIP-14), por se tratar de um dos instrumentos mais amplamente utilizados na avaliação da qualidade de vida. A utilização de materiais alternativos na reabilitação de pacientes, como a resina acrílica, traduz-se numa alternativa segura, rápida e com menor custo, podendo levar ao paciente funcionalidade satisfatória, numa melhora considerável em sua qualidade de vida em todos os âmbitos.

The multicystic ameloblastoma is an odontogenic lesion that mainly affects patients aged 20 to 49 years. Despite being a benign tumor it often presents an aggressive behavior that may require radical interventional therapy. Cases of extensive resections may represent the loss of a large portion of bone segment, producing severe aesthetic and functional sequelae, in addition to a diminished quality of life for the patient. Mandibular reconstruction represents an important stage in the rehabilitation of patients undergoing resection of large tumors. The use of titanium prostheses is a clinically reliable alternative, but is still inaccessible to most patients due to its high cost. It is therefore necessary to examine the use of affordable alternative materials. This paper presents a case of a 56-year-old male patient who came to the outpatient clinic of Oral and Maxillofacial Surgery of Hospital Restauração, complaining of pain and swelling on the right hemiface for about two years. The patient underwent a hemimandibulectomy following the diagnosis of ameloblastoma, followed by immediate rehabilitation with a custom prosthesis made of acrylic resin. The perceived needs of the patient, and the gain in quality of life were assessed before and after treatment using the questionnaire Oral Health Impact Profile - OHIP-14, because it is one of the most widely used instruments in the assessment of quality of life. The use of alternative materials such as acrylic resin in the rehabilitation of patients represents a safe, rapid and low-cost alternative option that may afford the patient a satisfactory functionality and a considerable improvement in quality of life in all areas.

Osteoma periférico da região maxilofacial: um estudo de 10 casos / Peripheral osteoma of the maxillofacial region: a study of 10 cases

Osteoma periférico é uma neoplasia benigna, com baixa taxa de recorrência. Sua incidência é rara nos maxilares e a mandíbula é mais afetada do que a maxila. Na maioria dos casos, é descoberto durante exames radiográficos de rotina. OBJETIVO: O objetivo deste trabalho é mostrar a experiência dos autores no tratamento desta neoplasia. MÉTODO: Em um estudo retrospectivo de janeiro de 2002 a dezembro de 2007 foram avaliados dez casos de osteoma periférico na região maxilofacial, tratados cirurgicamente por remoção completa da lesão, seguido de confirmação histológica. Nenhum dos casos estava correlacionado com a síndrome de Gardner. RESULTADOS: Nesta série avaliada, a incidência desta neoplasia foi maior no gênero feminino (1,5:1), com média de idade de 39 anos, sem predileção por faixa etária. Um dos pacientes apresentou recidiva da lesão após dois anos da primeira cirurgia, tendo sido submetido à nova intervenção, sem sinais de recidiva após três anos e seis meses de acompanhamento. CONCLUSÃO: O tratamento cirúrgico para o osteoma periférico é efetivo, com baixa taxa de recidiva.

Peripheral osteoma is a benign neoplasm, with low recurrence rate. Its incidence is rare in the jaws and the mandible is more affected than the maxilla. In most cases it is discovered during routine radiographic examinations. OBJECTIVE: The aim of this study is to show the author's experience regarding the treatment of this neoplasm. METHODS: A retrospective study from January 2002 to December 2007 including ten cases of peripheral osteoma in the maxillofacial region which were treated surgically by removal of the lesion followed by histological confirmation. None of the cases were correlated with Gardner's syndrome. RESULTS: In this series the incidence of this neoplasm was higher in females (1.5:1) with a mean age of 39, without age preference. One of the patients had lesion recurrence two years after the first surgery, having been submitted to another intervention, with no signs of relapse after three years and six months of follow-up. CONCLUSION: Surgical treatment is effective for peripheral osteoma with a low recurrence rate.

Linfoma não-Hodgkin de células t na mandíbula. relato de caso / T-cell non-Hodgkin lymphoma in the mandible: a case report

o linfoma não-Hodgkin de células T é uma doença rara, complexa, e que, de acordo com estudos recentes, vem aumentando na população, nos últimos anos. Pacientes com alterações imunológicas estão mais suscetíveis aos linfomas e, recentemente, pacientes acometidos por algumas doenças virais também foram incluídos no grupo de risco para o linfoma não-Hodgkin. o objetivo deste trabalho foi o de relatar um caso raro de linfoma não-Hodgkin de células T com manifestação na mandíbula, diagnosticado em um paciente jovem e destacar a importância dos profissionais de saúde no reconhecimento das neoplasias maxilomandibulares.

T-cell non-Hodgkin lymphoma is a rare, complex disease, and the population affected has been increasing in recent years according to recent studies. Patients with immunologic abnormalities are more susceptible to lymphomas and, recently, some patients affected by viral diseases have also been included in the risk group for non-Hodgkin lymphoma. The aim of this study was to report a rare case of non-Hodgkin T-cell expression in the jaw diagnosed in a young patient and to highlight the important role of health professionals in the recognition of maxillomandibular neoplasms.

Ameloblastoma: report of two cases and a brief literature review / Ameloblastoma: presentación de dos casos y una breve revisión de la literatura

Ameloblastoma is an uncommon odontogenic neoplasm that accounts for approximately 10 percent of all tumors originating from gnathic bones. Although its growth is localized, the tumor can also be infiltrative and persistent; however, its behavior is usually benign. The mandible is the most commonly affected site, and ameloblastoma is most frequently diagnosed between the fourth and fifth decades of life. In addition to a brief review of the literature, the present study discusses the clinical, imaging, histopathological and prognostic characteristics of these tumors by presenting two case reports. In these cases, the patients were aged 40 and 66 years, of different sexes and ethnicities and presented with the same complaint regarding localized and asymptomatic swelling. Both cases occurred in the posterior region (but on opposite sides) of the mandible. The patients were initially subjected to clinical examination and imaging of the face, followed by incisional biopsy to confirm (in both cases) the diagnosis of multicystic intraosseous ameloblastoma with a plexiform pattern. Both patients were treated by wide resection of the lesion (with safety margins), and only one patient experienced tumor recurrence. After 42 and 68 months of follow-up, the patients are still alive and show no signs of recurrence. Clinical and imaging findings aid in the differential diagnosis of ameloblastomas; however, histopathological evaluation is essential for its definitive diagnosis. Early diagnosis and precise detection of the borders to provide adequate safety margins during the surgical resection of the tumor are necessary to achieve successful treatment and recurrence-free survival for solid ameloblastomas.

El ameloblastoma es un tumor odontogénico infrecuente que representa aproximadamente 10 por ciento de todos los tumores que se originan a partir del maxilar y mandíbula. Aunque su crecimiento es localizado, el tumor puede ser infiltrante y persistente, y su comportamiento suele es benigno. La mandíbula es el sitio más comúnmente afectado, y el ameloblastoma se diagnostica con más frecuencia entre la cuarta y quinta década de la vida. Junto con una breve revisión de la literatura, el presente estudio analiza los datos clínicos, imágenes, características histopatológicas y pronóstico de estos tumores mediante la presentación de dos casos. En estos casos, los pacientes tenían entre 40 y 66 años, eran de diferentes sexos y grupos étnicos, que presentan la misma queja en relación con aumento de volumen localizado y asintomática. Ambos casos ocurrieron en la región posterior (pero en lados opuestos) de la mandíbula. Los pacientes fueron sometidos inicialmente a un examen clínico e imagenológico, seguido de la biopsia incisional para confirmar (en ambos casos) el diagnóstico de ameloblastoma multiquístico intraóseo tipo plexiforme. Ambos pacientes fueron tratados con amplia resección de la lesión (con márgenes de seguridad), y sólo un paciente presentó recurrencia del tumor. Después de 42 y 68 meses de seguimiento, los pacientes están vivos y sin signos de recurrencia. Los resultados clínicos e imagenológicos ayudan en el diagnóstico diferencial del ameloblastomas, sin embargo, la evaluación histopatológica es esencial para su diagnóstico definitivo. El diagnóstico prematuro y la precisa detección de las márgenes de la lesión proporcionan márgenes de seguridad adecuadas durante la resección quirúrgica del tumor y son necesarios para lograr el éxito del tratamiento y la supervivencia libre de recurrencia en los ameloblastomas sólidos.