Luiz Carlos Ferreira da Silva

Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables.

Objective: This paper investigates the relationship between preoperative findings and short-term outcome in third molar surgery. Study design: A prospective study was carried out involving 80 patients who required 160 surgical extractions of impacted mandibular third molars between January 2009 and December 2010. All extractions were performed under local anesthesia by the same dental surgeon. Swelling and maximal inter-incisor distance were measured at 48 h and on the 7th day postoperatively. Mean visual analogue pain scores were determined at four different time periods. Results: One-hundred eight (67.5%) of the 160 extractions were performed on male subjects and 52 (32.5%) were performed on female subjects. Median age was 22.46 years. The amount of facial swelling varied depending on gender and operating time. Trismus varied depending on gender, operating time and tooth sectioning. The influence of age, gender and operating time varied depending on the pain evaluation period (p < 0.05). Conclusions: Short-term outcomes of third molar operations (swelling, trismus and pain) differ depending on the patients’ characteristics (age, gender and body mass index). Moreover, surgery characteristics such as operating time and tooth sectioning were also associated with postoperative variables. Key words:Third molar extraction, pain, swelling, trismus, postoperative findings, prediction.

The prevalence of actinic cheilitis in farmers in a semi-arid northeastern region of Brazil

Background  Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to solar radiation. Despite being a relatively common lesion in tropical countries, the data related to AC prevalence in Brazil are sparse, particularly in regions with high levels of ultraviolet radiation.

Comparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery.

The aim of this randomized, double-blind clinical trial was to investigate the effect of preemptive analgesia with a combination of tramadol+dexamethasone or tramadol+diclofenac sodium. The study included 30 patients (age range: 16-30 years), who were randomly assigned to 2 groups by the split-mouth method. Postoperative pain was assessed with a visual analogue scale at 4, 6, 12, 24, and 48 h postoperatively (p.o.h.). Swelling was measured at 48 p.o.h. Maximal interincisor distance was measured at 48 p.o.h. and 7 postoperative days (p.o.d.). Significant differences in postoperative pain intensity were detected between the drug combinations at 4, 6, and 12p.o.h., suggesting the importance of preemptive analgesia. Patients treated with tramadol+dexamethasone showed lower pain scores compared to the tramadol+diclofenac sodium combination, larger postoperative mouth opening, and less swelling. The tramadol+dexamethasone combination also was more effective than tramadol+diclofenac sodium at reducing inflammation.

Traumatic bone cyst of the mandible: a review of 26 cases

UNLABELLED The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws. OBJECTIVE To describe the clinical, surgical and radiographic findings of traumatic bone cysts. MATERIAL AND METHOD A retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered. RESULTS Twenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions. CONCLUSION A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.O cisto osseo traumatico e uma entidade patologica caracterizada pela presenca de uma cavidade ossea assintomatica desprovida de revestimento epitelial, sendo raramente encontrado nos maxilares. OBJETIVO: Descrever as caracteristicas clinico-cirurgicas e radiograficas dos cistos osseos traumaticos. MATERIAL E METODO: Estudo de carater retrospectivo dos pacientes diagnosticados com cisto osseo traumatico em um servico de patologia oral no periodo de 1992 a 2007. Informacoes referentes as caracteristicas clinicas, radiograficas e cirurgicas foram coletadas. RESULTADOS: Vinte e seis casos de cisto osseo traumatico foram diagnosticados no periodo de 15 anos, 17 pertencentes ao sexo masculino e 09 ao sexo feminino. A maioria dos pacientes afetados pertencia as duas primeiras decadas de vida, nao relatava sintomatologia dolorosa, bem como historia de trauma na regiao da lesao. O padrao multilocular foi observado em apenas sete casos, dando as lesoes uma aparencia radiografica tumoral. A presenca de ar no interior da cavidade patologica foi relatada em aproximadamente 70% dos casos, sendo rara a presenca de conteudo serossanguineo e seroso. CONCLUSAO: A maior prevalencia de casos em pacientes jovens, a infrequente historia de trauma e o pequeno numero de lesoes com conteudo serossanguineo refletem a necessidade de se discutir a real patogenese do cisto osseo traumatico.

Prevalence of and risk factors for actinic cheilitis in Brazilian fishermen and women.

This study was conducted to investigate the prevalence of and risk factors for actinic cheilitis (AC) in Brazilian fishermen and women.

Oral lesions in renal transplant.

Abstract To prevent rejection of kidney transplants, patients must be kept in immunosuppressive therapy for a long time, which includes the use of drugs such as cyclosporine, azathioprine, cyclophosphamide, and prednisone. The action of these drugs reduces the general immune response of transplant patients and thus increases their susceptibility to infections. Moreover, these drugs increase the potential of developing lesions. Therefore, oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. The aim of this study was to investigate oral lesions in a group of 21 kidney transplant patients under immunosuppressive therapy attended during a 1-year period in the Nephrology Department of the Federal University of Sergipe, Brazil. Data related to sex, age, etiology of renal disease, types of renal transplant, time elapsed after transplantation, immunosuppressive treatment, use of concomitant agents, and presence of oral lesions were obtained. All patients received a kidney transplant from a living donor, and the mean posttransplantation follow-up time was 31.6 months; 71.5% used triple immunosuppressive therapy with cyclosporine A, azathioprine, and prednisone. Ten patients were also treated with calcium-channel blockers. Of the 21 transplant patients, 17 (81%) presented oral lesions. Gingival overgrowth was the most common alteration, followed by candidiasis and superficial ulcers. One case of spindle cell carcinoma of the lower lip was observed. Oral cavity can harbor a variety of manifestations related to renal transplantation under immunosuppressive therapy.

Inverted papilloma (Schneiderian papilloma) with involvement of the oral cavity: report of an unusual case

Inverted Schneiderian papilloma (ISP) is a neoplasm of epithelial lining origin which arises in the respiratory mucosa that lines the nasal cavity and paranasal sinuses. The inverted Schneiderian papilloma frequently appears as a unilateral lesion in the nasal septum and extends secondarily to the nasal and paranasal sinuses. This paper reports an unusual case of this pathology with involvement of the oral cavity in a 61-year-old white man. Clinical evaluation revealed a vegetating mass in the alveolar ridge of the right maxilla that had been present for approximately 4 months. After radiographic evaluation, involvement of the maxillary sinus was detected. Microscopic evaluation, in situ hybridization and immunohistochemical analysis of the specimen led to a diagnosis of ISP moderate dysplasia associated with HPV infection.

Papillary cystadenoma of the upper lip.

To the Editor: We found a rare case of oral papillary cystadenoma in a 53-year-old woman. The lesion appeared as a 0.5-cm–diameter, well-circumscribed, solid swelling at the upper lip mucosa (Fig. 1). The patient denied having a history of local trauma, and her medical history was not contributory. Surgical removal was the treatment of choice, and histologically, the specimen was characterized as a wellcircumscribed cystic nodule with a papillary intraluminal projection characterized by epithelial cells arranged in multiple microcystic spaces with proteinaceous fluid (Fig. 2A). The cystic spaces were lined by cuboidal and columnar cells with areas of oncocytic metaplasia (Fig. 2B). No lymphoid stroma was found, and there were no mitotic figures or cytologic atypia. The literature shows that papillary cystadenomas are common neoplasms in the appendix, ovary, and pancreas 1 but are extremely rare in the oral cavity, especially in the upper lip. Until this moment, only 4 cases in this location were described 2–5 (Table 1). Histologically, the lesions are characteristics and the presence of oncocytic cells is common, although the real significance of this differentiation is not fully understood. The major diagnostic challenge is to differentiate the lesion from cystadenocarcinoma because of the similar architecture of both neoplasms and the lack of atypia of cystadenocarcinoma. Differentiation of these tumor types depends largely on the identification of actual infiltration of salivary gland parenchyma or surrounding connective tissue by either cystic or solid epithelium in cystadenocarcinoma. 2,6 In the current study, no signs of malignant transformation were observed. We concluded that, although uncommon in the oral cavity, papillary cystadenoma should be included in the differential diagnosis of the nodular lesions located in the soft tissues, especially in the upper lip. In addition, an accurate histologic analysis is essential to avoid misdiagnosis and unnecessary treatments.

Criteria for the request of preoperative tests among oral and maxillofacial surgeons

OBJECTIVE The aim of this study was to analyze the criteria employed for the requesting of preoperative tests among maxillofacial surgeons. MATERIALS AND METHODS Thirty maxillofacial surgeons working in Aracaju (Brazil) received a questionnaire to fill out. The study inquired about the practice of requesting preoperative tests for healthy patients scheduled to undergo elective surgery. RESULTS Most of the surgeons interviewed requested tests that are not recommended for the case in question. The highest frequency of requests was a complete blood count, coagulation test, blood glucose test and chest radiograph. CONCLUSION The absence of strict rules for the requesting of preoperative tests causes uncertainty and a lack of criteria regarding pre-surgical conduct. It was not possible to clearly define the criteria used by surgeons for requesting such tests, as the clinical characteristics of the hypothetical case presented suggest a smaller number of tests.

A rare case of iatrogenic gingival Kaposi’s sarcoma

Kaposis sarcoma is an angioproliferative tumour rarely found in the oral cavity. We present the 3rd case of iatrogenic gingival Kaposis sarcoma reported in the English-language literature which developed in a young patient 5 years after a renal transplant and discuss their histological features and differential diagnosis.