Dexamethasone in preventive analgesia alleviates pain and complications after jaw cyst enucleation: a randomized controlled trial.

BACKGROUND: Dexamethasone is widely used in the prevention of postoperative complications in oral surgery and strengthening the analgesic effect after anesthesia, but the efficacy is controversial, and the relationship between postoperative complications and pain is still unclear. The purpose of this study was to evaluate the analgesic effect of dexamethasone in the treatment of jaw cyst and to explore the relationship between postoperative complications and pain. METHODS: We conducted a prospective, randomized, double-blind clinical trial. 120 patients were divided into two groups, dexamethasone group ( group D) and control group (Group C). All patients were given 0.02 mg·kg-1 of hydromorphone to relieve pain in advance at 10 min before the beginning of operation. Meanwhile, dexamethasone was injected 0.2 mg·kg-1 intravenously in group D and normal saline was injected in group C. The primary endpoint was pain intensity at 2 h, 6 h, 12 h, 24 h and 48 h after surgery. The secondary endpoints were the incidence and extent of complications after surgery, including facial swelling and trismus. RESULTS: Compared with group C, the visual analogue scale (VAS) scores and occurrence of painful event postoperatively in group D were significantly lower both at rest (P < 0.0001 and P = 0.0014) and during mobilization (P < 0.0001 both). The degree of facial swelling and trismus in group D were significantly lower than that in group C at 24 h (P < 0.0001 and P = 0.00022) and 48 h (P < 0.0001 and P = 0.00015) after surgery, but there was no difference at 6 h and 12 h (P = 0.137 and P = 0.083) after surgery. The C-reactive protein (CRP) level at 24 h after operation in group D was lower than group C (P = 0.012), but there was no significant difference in blood glucose concentration between the two groups (P = 0.608). CONCLUSION: Dexamethasone can reduce the degree of facial swelling and trismus after jaw cyst surgery by inhibiting the production of inflammation, which alleviated the postoperative pain of patients significantly. In addition, it did not increase the risk of hyperglycemia. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry on May 07, 2020 (URL: http://www.chictr.org.cn/showproj.aspx?proj=53344 . Registry number: ChiCTR2000032693). Registered on 07/05/2020.

Cisto ósseo traumático associado a odontoma composto: relato de um caso incomum / Aneurismal bone cyst with a compound odontoma: unusual case report

Introdução: o cisto ósseo traumático (COT) é um pseudocisto que se apresenta assintomático e é descoberto frequentemente em exames de rotina. Outra lesão também presente nos maxilares é o odontoma, sendo dividido em dois subtipos, o composto e o complexo; os odontomas são geralmente descobertos como um achado acidental, visto que não apresentam sintomatologia. Objetivo: relatar um caso incomum de um COT, associado à odontoma composto (OC). Relato de caso: paciente do gênero masculino, 16 anos de idade, compareceu à clínica escola de odontologia da Universidade Federal de Campina Grande (UFCG), campus Patos, PB, referenciado pelo cirurgião-dentista após solicitar exame radiográfico para tratamento ortodôntico e observar lesão radiolúcida em região anterior da mandíbula. Durante a anamnese, o paciente não relatou nenhuma alteração sistêmica ou doença de base, mas relatou trauma de infância na região acometida. No exame clínico intraoral, não foi observado nenhum aumento de volume na região. Realizou-se palpação na região, não havendo relato de dor. Ao analisar a radiografia panorâmica, observou-se a presença de pequenas estruturas calcificadas com radiopacidade semelhante às estruturas dentárias, delimitada por uma linha radiolúcida, sugestiva de OC. Para melhor localização, delimitação, relação com estruturas anatômicas e planejamento cirúrgico da lesão, foi solicitado um exame de tomografia computadorizada de feixe cônico (TCFC). Considerações finais: com base nos achados clínicos e radiográficos, optou-se por abordagem cirúrgica da lesão cística e enucleação do OC, sob anestesia local. No pós-operatório de um ano, o paciente evoluiu satisfatoriamente sem queixas clínicas.(AU)

Introduction: traumatic bone cyst (TBC) is a pseudocyst that usually presents asymptomatically and is found frequently in routine exams. Another lesion also present in the jaws is odontoma. The odontoma is divided into two subtypes, the compound and the complex; odontomas are usually discovered as an accidental finding, since they do not present symptomatology. Objective: the present article aims to report an unusual case of a TBC associated with a composite odontoma. Case report: a 16-year-old male patient attended the Clinic School of Dentistry of the Universidade Federal de Campina Grande (UFCG), Patos-PB campus, referenced by the dentist after identify radiolucent lesion in the anterior region of the mandible on radiographic examination for orthodontic treatment. During the anamnesis, the patient did not report any systemic alteration or underlying disease, but reported trauma in the region affected in childhood. The intra oral clinical examination, was not observed any increase in volume in the region. Palpation was performed in the region, and there was no report of pain. When analyzing panoramic radiography the presence of small calcified structures with radiopacity similar to dental structures was observed, delimited by a radiolucent line, suggestive of compound odontoma. To better location, delimitation, compared with anatomy and surgical planning of the injury, it was requested an cone beam computed tomography (CBCT). Final considerations: based on the clinical and radiographic findings, we opted for a surgical approach to cystic lesion and enucleation of composite odontoma, under local anesthesia. In the one-year postoperative period, the patient progresses satisfactorily without clinical complaints.(AU)

Fractura mandibular tardía post exodoncia de molares inferiores. Caso clínico / Late mandibular fracture after lower third molar extraction: a case report

La extracción del tercer molar es un procedimiento común en cirugía oral. Una de las complicaciones es la fractura mandibular. Con una incidencia postoperatoria menor a un 0.005%. Los factores que contribuyen al riesgo de fractura del ángulo mandibular después de una extracción del tercer molar incluyen el nivel de impactación, la anatomía del diente, infecciones locales previas, edad, sexo, presencia de formaciones quísticas y bruxismo entre otras. Presentamos un caso clínico de fractura mandibular postoperatoria a las cinco semanas tras la exodoncia del 47 y 48 incluidos en posición horizontal. El objetivo final del tratamiento de una fractura mandibular es la consolidación ósea manteniendo la oclusión dental. En nuestro caso, al no tratarse de una fractura que sobrepasaba las corticales y sin desplazamiento mandibular, no fue subsidiaria de un tratamiento quirúrgico y se resolvió con reposo funcional

The lower third molar extraction is a common procedure in oral surgery. One of its complications, although uncommon, is the mandibular fracture. Postoperatively, it has an incidence lower than 0.005%. The factors that may contribute to the risk of the mandibular angle fracture after an extraction of the third molar include the level of impaction are the anatomy of the tooth, previous local infections, age, sex, cysts and bruxism among others. We present a clinical case of postoperative mandibular fracture at five weeks after the extraction of 47 and 48 included in horizontal position. The ultimate treatment goal of a mandibular fracture is to reach a bone consolidation with the premorbid dental occlusion. In our case, as it was not a fracture that surpassed the cortical and there was not a mandibular displacement, it was not need a surgical treatment so it was resolved with functional rest

Repair of oroantral fistula via modified endoscopic medial maxillectomy with free nasal mucoperichondrial-osteal graft.

Background: Many techniques have been proposed to close an oroantral fistula (OAF), with most of them involving transoral repairs with oral soft tissue flaps. An additional Caldwell-Luc approach or endoscopic sinus surgery (ESS) is required to address coexisting maxillary sinusitis. Objectives: This study presents the endonasal closure of an OAF through modified endoscopic medial maxillectomy (MEMM) with a free nasal mucoperichondrial-osteal graft. Materials and methods: Sixteen OAF patients who underwent closure operations in our department from May 2013 to June 2018 were retrospectively reviewed. Results: The main cause of OAF was maxillary dental cysts (56.25%). The OAF size ranged from 2 × 2 to 10 × 15 mm. The first molar (62.5%) was the most frequently involved tooth. All closures were made via MEMM, using nasal mucoperichondrial-osteal grafts harvested from the septum or nasal base. All patients were followed up for at least six months. Successful closure after a single procedure was achieved in 93.75% of cases. No obvious complications or recurrences were observed. Conclusions: Endonasal repair of OAFs via MEMM with free nasal mucosal grafts is feasible and promising. The approach preserves the normal oral and nasal physiology after surgery. It could be used alone for the closure of small to medium-sized OAFs.

Marsupialization facilitates movement of the cystic lesion-associated deeply impacted mandibular third molar in spite of its mature roots

Background: The odontogenic cystic lesions happened in the angle and ramus region are frequently associated with impacted mandibular third molars. The treatment plan was difficult to work out for the huge cystic lesions with deeply impacted third molars, since the enucleation with simultaneously removing the deeply impacted teeth may cause serious complications. Therefore, the marsupialization of the cystic lesions followed by enucleation with tooth removal has also been advocated. The aim of this study was to explore the movement of cystic lesion associated deeply impacted mandibular third molars (IMTM) after marsupialization. Material and Methods: Between July 2009 and December 2015, patients who had mandibular cystic lesion associated with IMTM and underwent marsupialization followed by enucleation with tooth extraction were included in our retrospective study. The clinical and pathological data was collected. The distance and direction of movement of the IMTM after marsupialization was measured on panoramic radiograph and computed tomography. Results: Four male and six female patients whose ages ranged from 14 years to 67 years were enrolled in this study. Among the all impacted molars, there were 3 cases with mature roots. After marsupialization, all the cystic lesions shrunk and all impacted teeth moved toward the bony windows, and the distance of tooth movement were from 8.3mm to 12.1mm. The complications included swelling and pain, while no numbness of the ipsilateral lower lip was happened. Conclusions: Marsupialization can promote the movement of impacted teeth with or without mature roots, and may be an optimal treatment approach for the huge posterior mandibular cystic lesions with deeply impacted third molar (AU)

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[The nasolabial cyst encountered in the practical work of the otorhinolaryngologists]. / Nosogubnaya kista v praktike otorinolaringologa.

Two clinical observations of nasolabial cyst of uni- and bilateral localizations are reported. The comprehensive characteristic of nasolabial cysts is presented with special reference to the principal diagnostic criteria for this pathology and the potential diagnostic errors.

Aspectos técnicos do tratamento do cisto ósseo traumático: relato de caso / Technical aspects of treatment of the traumatic bone cyst: case report

Objetivo: Este trabalho objetiva relatar um caso clínico de um cisto ósseo traumático, enfatizando a técnica cirúrgica. Relato do caso: Paciente gênero feminino, 15 anos de idade, foi encaminhada ao departamento de cirurgia oral e maxilofacial, Universidade Federal de Campina Grande, para avaliação de lesão intra-óssea em região anterior da mandíbula. O exame radiográfico evidenciou área radiolúcida unilocular e assintomática associada ao ápice dos incisivos inferiores esquerdo, que apresentavam vitalidade pulpar. A paciente não referia trauma na infância, apesar de apresentar cicatriz na região submentual. Foi feito o diagnóstico clínico de cisto ósseo traumático, sendo a exploração cirúrgica e curetagem do defeito ósseo o tratamento de escolha. No pós-operatório de um ano, a paciente evolui satisfatoriamente, sem queixas clínicas. Conclusão: Por apresentar comportamento não-agressivo, o cisto ósseo traumático responde adequadamente ao tratamento conservador através da curetagem cirúrgica.

Objective: This study aim report a clinical case of a traumatic bone cyst, emphasizing the surgical technique. Case report: Patient female, 15 years-old, was referred to the oral and maxillofacial surgery department, Federal University of Campina Grande, for evaluation intra-osseous lesion in the anterior mandible. Radiographic examination evidenced a unilocular area asymptomatic and associated to the apex of the under left incisive, who presented pulp vitality. The patient reported no trauma in childhood, although presenting a scar on the submental region. The clinical diagnosis of traumatic bone cyst was performed, surgical exploration and curettage of the bone defect was the treatment of choice. Postoperative period of one year, the patient progressed satisfactorily without clinical complaints. Conclusion: Presentation non-aggressive behavior, the traumatic bone cyst responds adequately to conservative treatment by surgical curettage.

An underestimated "ghost" foreign body as an unusual cause of mandibular osseocutaneous fistula formation: impacted spike of a soccer cleat.

In this article, the case of a patient with osteocutaneous fistula at the left malar region secondary to impacted spike of a soccer cleat to the mandible is presented. Both the clinical and radiologic diagnoses failed because of an obscure anamnesis of the patient and the unavailability of viewing the spike in orthopantomogram and computed tomography. Surgical extirpation was performed to the 41-year-old man who was injured in a football match 3 months before the presentation and had a swooning history after an accidental booting. There were no early or late complications after the surgery at the end of 9 months. This study shows the importance of both obtaining a definite history of patients and sequential radiologic imaging to make a differential diagnosis between the foreign bodies and cystic or noncystic tumors and inflammatory lesions of the mandible.

Mandibular condylar pseudocyst: an introduction to the orthodontist.

The aims of this article are to introduce mandibular condylar pseudocysts to orthodontists, present 2 relevant case reports, and discuss possible differential diagnoses. Condylar pseudocyst is a radiologic variant of pterygoid fovea, which is the site of insertion of the lateral pterygoid muscle to the head of the mandibular condyle. A pathognomonic picture of a solitary well-defined radiolucency with radiopaque borders, located on the anterior aspect of the condyle in an asymptomatic orthodontic patient, is characteristic.

Submandibular abscess due to an infected keratocystic odontogenic tumor associated with simultaneous occurrence of a traumatic bone cyst: a rare case report.

AIM: The aim of this report is to introduce a rare case in which an infected keratocystic odontogenic tumor (KCOT) was initially diagnosed and treated as a dentoalveolar abscess. BACKGROUND: Keratocystic odontogenic tumor (KCOT) is a benign neoplasm that can be secondarily infected. However, cervical soft tissue abscess formation as a result of an infected odontogenic cyst or tumor is a rare condition few of which have only been described in the existing literature. Also, there has been a single report regarding the coincidence of a traumatic bone cyst and a keratocytic odontogenic tumor to date. CASE REPORT: The patient was a 29-year-old male, complaining of fever, pain and swelling in the left submandibular region. The panoramic radiography showed a well-defined and partially corticated radiolucency between the roots of the second and third left mandibular molars. In addition, a well-corticated radiolucent lesion was incidentally found on the right side of the mandible, which, following surgical exploration, was diagnosed as a traumatic bone cyst. CONCLUSION: In the present report, an infected KCOT manifested as a cervical abscess, coincided with a traumatic bone cyst. CLINICAL SIGNIFICANCE: From the clinical point of view, it is of paramount significance to prevent misdiagnosis of similar presentations as pulp and periapical lesions, which may lead to mistreatment and thus complications.

Pathological mandibular fractures: a review of the literature of the last two decades.

Pathological mandibular fractures are rare, accounting for fewer than 2% of all fractures of the mandible. They could be defined as fractures that occur in regions where bone has been weakened by an underlying pathological process. Pathological fractures usually may follow surgical interventions such as third molar removal or implant placement, result from regions of osteomyelitis, osteoradionecrosis, and bisphosphonate-related osteonecrosis of the jaw, occur because of idiopathic reasons or be facilitated by cystic lesions, benign, malignant, or metastatic tumors. Pathological mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred.

Surgical management of pathologic mandibular fractures.

BACKGROUND: The aim of this article was to present our experience in the management of pathologic mandibular fractures. METHODS: We conducted a retrospective analysis of 14 patients with pathologic mandibular fractures associated with osteoradionecrosis, bisphosphonate-related osteonecrosis of the jaw, benign/malignant lesions, osteomyelitis, idiopathic, or iatrogenic etiology. Data collected included age, sex, etiology, site, treatment, and outcome. RESULTS: Five patients had iatrogenic fractures, 3 patients had osteomyelitis, 2 had benign cystic lesion, and the remaining 4 had primary squamous cell carcinoma, histiocytosis, multiple myeloma, and bisphosphonate-related osteonecrosis of the jaw, respectively. Eleven fractures of 14 were treated using a 2.4-mm mandibular plate. CONCLUSIONS: Pathologic mandibular fractures may be challenging to treat because of their different etiology and peculiar local and general conditions, often requiring a more rigid fixation. In patients with poor medical conditions, simpler and more limited options may be preferred.

[Diseases of the maxillary sinus: an overview]. / Afwijkingen van de sinus maxillaris: een overzicht.

Because of the intimate relationship between the maxillary teeth and the maxillary sinus, it is no surprise that odontogenic infections, odontogenic cysts and tumours which have their origin in the mucosa and the bone of the maxilla may extend into the maxillary sinus and, occasionally, into the nasal cavity. Diseases of the maxillary sinus can also extend into the oral cavity and can cause symptoms that mimic those of odontogenic diseases. Important diseases of the maxillary sinus are maxillary sinusitis, oroantral communications, antroliths, cysts and neoplasms.

Trauma, solitary bone cyst and delayed eruption of permanent mandibular incisors. an unusual case in a 7-year-old patient.

BACKGROUND: Solitary bone cysts (SBC) are uncommon non-neoplastic bone lesions, which present mainly in the mandible. Their aetiology is still obscure, but it has been suggested that they may be a result of trauma in the region. Due to their asymptomatic nature, SBCs are revealed mainly accidentally during routine radiographic examination. Sometimes, patients complain of pain or delayed eruption of teeth. Treatment is recommended because, otherwise, the cyst may become symptomatic or cause a pathologic mandibular fracture. CASE REPORT: A 7-year-old Caucasian boy presented with delayed eruption of his permanent incisors. His parents reported a history of trauma at 3 years of age. The radiographic examination revealed a bony lesion, largely displacing the permanent incisors and preventing their eruption. TREATMENT: Surgical exploration of the lesion was carried out and the histopathological examination result was consistent with a SBC. FOLLOW-UP: Two years after the surgical curettage there was radiographic evidence of considerable bony regeneration. The permanent incisors erupted and were vital. CONCLUSION: Clinicians should be aware that SBC is associated with trauma, mainly of the mandible, and with a possible delay of eruption of the corresponding teeth.

Cystic lesions of the jaws in edentulous patients: analysis of 27 cases.

In this retrospective study we reviewed the distribution, characteristics, and treatment of 27 cystic jaw lesions in edentulous patients, and compared these with 242 cysts in dentate patients. The mean age was 60 years (range 46-74), and the male:female ratio 4.4:1. The maxilla was more affected than the mandible, with radicular/residual cysts being the most common. Patients were treated by marsupialisation, enucleation, or enucleation with bone grafting. Edentulous men were at higher risk than women of developing cystic lesions in the maxilla. Patients who are edentulous alert us to the possibility that their general health may be compromised, and this should be kept in mind when planning treatment.

Investigation of impacted permanent teeth except the third molar in Chinese patients through an X-ray study.

PURPOSE: To investigate the incidence and the local factors of impacted permanent teeth, except for the third molar, in Chinese patients through an x-ray study. MATERIALS AND METHODS: A total of 548 impacted permanent teeth from panoramic radiographs were studied and recorded according to the patients' gender and age, tooth position, and classification of impaction. The local factors contributing to impacted permanent tooth were also investigated. RESULTS: The incidence of impacted permanent teeth in the Chinese was 6.15%. The impacted tooth showed a predilection for women and was more common in the maxilla. The impaction of the canine had the greatest occurrence, 28.10% of all impacted teeth. Vertical impaction was most common (49.09%). The chief local factor for impacted teeth was the lack of interdental space (49.64%). CONCLUSIONS: All permanent teeth can occur with impaction in Chinese patients. Dentists should perform a thorough evaluation before planning suitable treatment.