A Rare Case of a Large Ameloblastoma and Cervical Lynphoepitelial Cyst Treated Simultaneously by an Intraoral Approach and Immediate Reconstruction.

Ameloblastoma is a benign locally aggressive odontogenic tumor of epithelial origin with unlimited growth capacity. Cervical lymphoepithelial cyst is a developmental cyst located in the superior-lateral region of the neck with treatment consisting of surgical excision, which presents low recurrence rates. This article reports the case of patient J.G.S.L., 24 years old, female, who reported to the service with a histopathological evaluation compatible with intraosseous mandibular ameloblastoma. On physical examination, a nontender swelling was palpable along the body of left mandible where the ameloblastoma was located, with a fluctuant region detected just below it. Imaging exams confirmed the suspicion of two independent lesions. The treatment plan consisted of two stages: first, mandibular resection of the area affected by the ameloblastoma, followed by reconstruction with a titanium plate simultaneous to excisional biopsy of the as yet undiagnosed lesion, both through intraoral access; second, mandibular reconstruction with iliac crest graft. Histopathological examination of the second lesion indicated a diagnosis of cervical lymphoepithelial cyst, being the first case in the literature with these concomitant lesions. Currently, the patient is in her third postoperative year with no signs of recurrence.

Is Bilateral Sagittal Split Osteotomy of the Mandible With no Step Possible? A Modification in the Technique.

The mandibular ramus sagittal osteotomy is a usual procedure used to correct deformities of the lower third of the face. Modifications of the procedure will be presented to avoid the presence of palpable gap at mandibular body, easily seen in greater movements.

Implantes zigomáticos com desenho pentagonal para a reabilitação imediata da maxila / Pentagonal design zygoma fixtures anchorage for immediate maxillary rehabilitation

Introdução: os protocolos para a reabilitação de implantes zigomáticos com próteses fixas não permitem a carga imediata dos implantes até culminar todo o período de osseointegração dos implantes convencionais anteriores. Dado este problema, propôs-se o protocolo pentagonal que oferece uma excelente estabilidade primária e permite a carga imediata. Objetivo: identificar as vantagens e as desvantagens da colocação do quinto implante zigomático no âmbito do desenho pentagonal, com o carregamento imediato da prótese provisória e a prótese definitiva no prazo de 60 dias após a cirurgia, a fim de avaliar os resultados. Material e Métodos: 85 implantes zigomáticos foram colocados em 17 pacientes (12 mulheres, cinco homens) com idades entre 11 e 66 anos (com média de 54,5 anos), com atrofia óssea severa maxilar com o desenho pentagonal de implantes zigomáticos com carga imediata. Para testar a estabilidade, a passividade, o estado e a manutenção da prótese pelo paciente, foram efetuados controles pós-operatórios na primeira semana, no primeiro mês e a cada três meses (seis a 34 meses), com uma média de 20,59 meses. Resultados: o implante zigomático anterior permite a carga imediata da prótese provisória no dia da cirurgia e da prótese final no prazo de 60 dias depois da cirurgia, em adição a isto, biomecanicamente reduz o braço da alavanca e o cantiléver. Conclusão: o desenho zigomático pentagonal oferece uma ancoragem alternativa na maxila atrófica que permite a carga imediata sem esperar pela osseointegração convencional e, portanto, reduz o tempo de tratamento, resultando em maior estabilidade, melhor distribuição de forças, menor taxa de complicações protéticas e maior êxito a longo prazo.

Introduction: the actual zygoma fixtures protocols for maxillary dental rehabilitation do not allow immediate loading, since the regular implants require the osseointegration period. The quadrangular design often presents an anterior cantilever, needing additional anterior fixtures. Biomechanically, an extra anterior immediately loadable implant would be the solution. Purpose: to point out the advantages and disadvantages of the fifth zygoma implant placement under the pentagonal design with immediate loading and the final prosthesis installed within 60 days after surgery and evaluate the results. Materials and methods: 85 zygoma fixtures were placed with pentagonal design and immediate loading on 17 patients (12 females, 5 males) ages between 11 and 66 years old (average 54.5 y.o.) with severe maxillary atrophy. To evaluate stability, passivity, condition and maintenance capacity of the prosthesis by the patient, follow ups were made the first week, the first month and every three months (6-34 months) with an average of 20.59 months. Results: the anterior zygoma fixture allows immediate loading of the provisional prosthesis the day of the procedure and installation of the final prosthesis within 60 days after surgery, in addition, biomechanically reduces the lever arm and the cantilever. Conclusions: the pentagonal zygoma design offers an alternative anchorage on the atrophic maxilla, allowing immediate loading, eliminating the osseointegration waiting period, therefore the treatment time shortens with excellent stability, better forces distribution, less prosthetic complications and greater success rates in the long term follow-up.

Impacto dos meios de contraste iodixanol e loxaglato na repercussão miocárdica em pacientes submetidos a angioplastia no infarto agudo do miocárdio / Impact of contrast media iodixanol and loxaglate in myocardil reperfusion in patients submitted to primary coronary angioplasty in acute myocardial infarction

Introdução: Apesar do excelente desenpenho e da segurança da angioplastia primária em restabelecer o fluxo sanguíneo normal (fluxo TIMI, grau 3), uma significante proporção desses pacientes com infarto agudo do miocárdio (IAM) tem prejuízo na integridade microvascular e na perfusão miocárdica. É possível que os meios de contraste utilizados durante o procedimento interferiram na perfusão miocárdica. por alterarem mecanismos celulares implicados nesse processo. Objetivo: Comparar os meios de contraste iodixanol (não-iônico isomolar) e ioxaglato (iônico de baixa osmolaridade) na perfusão miocárdica tecidual em pacientes com IAM submetidos a intervenção coronária percutânea primária (ICPP). Método: Ensaio clínico randomizado com uma população de 201 pacientes com IAM, com tempo dor-porta maior menor 12 horas, submetidos a ICPP. O desfecho primário do estudo foi a presença de no-reflow, definido como corrected TIMI frame count (CTFC) menor ou menos 40 quadros, e o desfecho secundário foi a composição de morte cardíaca, reinfarto e acidente vascular cerebral (AVC) durante a hospitalização . Resultados: CTFC menor menos após ICPP ocorreu em 22,9 por cento dos pacientes mo grupo do ioxaglato...

Background: Despite the excellent performance and safety of primary angioplasty in reestablishing normal epicardial blood flow (TIMI flow, grade 3), a significant proportion of these patients with acute myocardial infarction (AMI) have damage in the microvascular integrity and impaired myocardial perfusion. It is possible that the contrast media used during the procedure interferes in myocardial perfusion by altering cell mechanisms involved in this process. Our objective was to compare contrast media iodixanol (nonionic isosmolar) and ioxaglate (ionic, low osmolality) in myocardial tissue perfusion in patients with AMI submitted to primary percutaneous coronary intervention (primary PCI). Methods: A randomized study with a population of 201 patients with AMI with a pain-door time ≤ 12 hours submitted to primary PCI. The primary end point of the study was the presence of no-reflow defined as corrected TIMI frame count (CTFC) ≥ 40 frames and the secondary end point was the composition of cardiac death, reinfarction and stroke during hospitalization. Results: CTFC ≥ 40 frames after primary PCI occurred in 22.9% of patients in the ioxaglate group and 19.8% in the iodixanol group (p = 0.611). The secondary end point occurred in 9.5% of patients in the ioxaglate group and 9.4% in the iodixanol group (p > 0.99). Conclusion: The current study did not demonstrate significant differences in the no-reflow incidence between the contrast media ioxaglate and iodixanol in patients with AMI submitted to primary PCI. Also significant differences were not observed in the incidence of the combined clinical outcomes of death, reinfarction or stroke.