Iêda Margarida Crusoé-Rebello

Accessory mental foramen: A rare anatomical variation detected by cone-beam computed tomography

The mental foramen is a bilateral opening in the vestibular portion of the mandible through which nerve endings, such as the mental nerve, emerge. In general, the mental foramen is located between the lower premolars. This region is a common area for the placement of dental implants. It is very important to identify anatomical variations in presurgical imaging exams since damage to neurovascular bundles may have a direct influence on treatment success. In the hemimandible, the mental foramen normally appears as a single structure, but there are some rare reports on the presence and number of anatomical variations; these variations may include accessory foramina. The present report describes the presence of accessory mental foramina in the right mandible, as detected by cone-beam computed tomography before dental implant placement.

Hybrid lesion: central giant cell granuloma and benign fibro-osseous lesion

Hybrid lesions comprise elements of different pathologies in one lesion. Hybrid lesions comprising central giant cell granulomas (CGCG) with fibro-osseous components are rare, with only six maxillomandibular cases reported in the literature. We report a case of a hybrid lesion in a 38-year-old woman who presented with a swelling in the mandibular parasymphysis, on the left side. Panoramic and occlusal radiographs and CT showed a mixed lesion with expansion of the buccal cortical plate that pointed to the diagnosis of ossifying fibroma (OF). Complete excision of the lesion was performed, and the anatomopathological examination showed features of both CGCG and a fibro-osseous lesion. Clinical, imaging and histopathological features indicate a hybrid lesion of CGCG and OF. The patient remains asymptomatic after 30 months of follow-up.

Branch of the canalis sinuosus: a rare anatomical variation—a case report

The canalis sinuosus (CS) is a neurovascular canal, a branch of the infraorbital canal through which the anterior superior alveolar nerve passes. There are no studies or case reports of anatomical variations related to this canal. A rare case of anatomical variation in the CS is reported that was detected by cone beam computed tomography done in a 47-year-old female as a pre-operative workup before dental implants. In this case, in the region slightly medial to tooth 23, a wide accessory branch from the CS was observed, running an intraosseous course in the inferior and posterior direction up to a foramen located in the hard palate, slightly medial in relation to tooth 23. The location of this branching, as well as its neurovascular component, is important for dental implant planning because of its proximity to the upper teeth. Identification of neurovascular bundles is fundamental to avoid complications for the patient.

Biometric parameters of the temporomandibular joint and association with disc displacement and pain: a magnetic resonance imaging study

The aim of this study was to evaluate the relationship between biometric parameters of the components of the temporomandibular joint (TMJ), articular disc displacement, and TMJ pain. Magnetic resonance imaging (MRI) examinations of 185 patients were assessed (39 males and 146 females (370 TMJs), mean age 41.3 years, range 18-79 years). The antero-posterior length of the condyle was measured in its medial and lateral regions, as well as the transverse length of the condyle. Possible associations between linear measurements of the condyle, presence of disc displacement, and joint pain were tested. Although pain was more commonly reported among patients with disc displacements, this association was not statistically significant. We found statistically significant associations showing that the antero-posterior length of the condyle at the lateral pole (D1L), the antero-posterior length of the condyle at the medial pole (D1M), and the transverse length of the condyle (D2) were higher among patients without disc displacements when compared to those with unilateral or bilateral displacements. This study showed that disc displacement was associated with smaller condyles in the antero-posterior and transverse dimensions when compared to condyles in subjects with normal disc position.

Morphometric features of the mandibular condyle and association with disk abnormalities.

OBJECTIVE The aim of this study was to evaluate the relationship between the morphometric characteristics of the condyle and temporomandibular joint (TMJ) disk displacement. STUDY DESIGN One hundred and nine individuals who underwent magnetic resonance imaging of the TMJ were evaluated. Linear (D1: condyle width; D2: condyle thickness) and angular (A1: horizontal condylar angle; A2: anterior condylar angle; A3: medial condylar angle) measurements were made. These measurements were associated with articular disk displacement, with and without reduction. RESULTS There was statistically significant association between limited D1 and D2 and between A1 above and A1 below the mean and displacement of the joint disk. There was statistically significant association between A2 and anterior displacement of the disk. Furthermore, thicker condyles and/or condyles with smaller horizontal angles and/or with smaller medial angles were associated with articular disk reduction. CONCLUSIONS The morphometric characteristics of the bony components of the TMJ are related to articular disk displacement and with its reduction or nonreduction.

Nonsurgical Management of Keratocystic Odontogenic Tumor: Report of aClinical Case

Because of its intrinsic characteristics consistent with neoplasms, the odontogenic keratocyst has joined the group of benign odontogenic tumors in 2005 and renamed keratocystic odontogenic tumor (KOT). The main characteristics of this pathology include: aggressive behavior, autonomous growth, high recurrence rate and, sometimes, silent clinical manifestation of lesions to large size. These peculiarities, combined with their frequency, delay diagnosis, prognosis and limited treatment difficult. This study aims to present a case of atypical KOT emphasizing its solvability without surgical intervention or invasive procedures, and comparing its clinical, radiological and histopathological characteristics and therapeutic alternatives to those described in the literature. The most common treatment for KOT is enucleation followed by curettage, but its friable nature, associated with a fibrous connective tissue with thin, hinders its complete removal. In large lesions, it has been chosen by marsupialization followed by enucleation. The advantages of this technique are the thickness of the capsule, the reduction in lesion size and, therefore, easy and complete removal lower recurrence rate. Due to the characteristics of this injury, it deserves special attention, since successful treatment depends on accurate diagnosis, an appropriate surgical procedure and an appropriate and periodic radiographic preservation, in order to prevent the appearance of new lesions in the area.

Cone beam computed tomography assessment of the pterygomaxillary region and palatine canal for Le Fort I osteotomy

The aim of this study was to evaluate the anatomical linear measurements of the descending palatine canal and the pterygomaxillary fissure for Le Fort I preoperative planning. Seventy-five patients, comprising 46 females (61.3%) and 29 males (39.7%), underwent multi-slice computed tomography examinations performed for preoperative orthognathic surgical planning. The images were categorized according to sex, craniofacial side, and skeletal and craniofacial patterns. The anterior length between the descending palatine canal and the lateral wall of the piriform rim showed a higher mean value for males compared to females (P=0.0121). The posterior distance also showed a difference between the sexes and the highest mean was observed in females (P=0.0295). Comparing the posterior width for the skeletal patterns, a statistical difference was observed between classes I and III (P=0.0371), and classes II and III (P=0.0094). Regarding the craniofacial patterns, the brachycephalic (P=0.0078) and mesocephalic (P=0.0015) groups showed a greater posterior width in females. In conclusion, the patients sex and aspects of the skeletal pattern and craniofacial pattern have an influence on the pterygomaxillary area and descending palatine canal anatomy. A preoperative computed tomography analysis involving this evaluation could reduce the risk of surgical complications.

Assessing bone thickness in the infrazygomatic crest area aiming the orthodontic miniplates positioning: a tomographic study

ABSTRACT Introduction: Due to the increasing use of miniplates for anchorage purposes in orthodontics, it is very important to know more about infrazigomatic crest anatomy (thickness), in adult patients. Objectives: Evaluate the infrazygomatic crest region thickness, in adult (male and female) patients. Methods: Cone-beam computerized tomography (CBCT) images from 40 patients were used to assess cross-sectional measurements of the infrazygomatic crest region. Measurement 1 considered thickness 2 mm above the distobuccal root of the permanent maxillary first molar, while measurement 2 was taken 2 mm above the first measurement. Results: The mean thickness of the infrazygomatic crest in males was 3.55 mm for measurement 1 and 2.84 mm for measurement 2, while in females these were 2.37 mm and 2.24 mm, respectively. Conclusion: The authors concluded that the overall mean thickness of the infrazygomatic crest was 2.49 mm with respect to measurement 1, and 2.29 mm for measurement 2, with no statistically significant differences between gender.