Marcelo Minharro Ceccheti

Treatment of Recurrent Mandibular Myxoma by Curettage and Cryotherapy after Thirty Years

Odontogenic myxoma is a slow-growing, painless, and site-aggressive tumor.1 Large-sized lesions may cause tooth dislodgement and cortical bone expansion.2,3 Since pain and hypoesthesia are not common, the lesion may reach a considerable size before the patient perceives its existence and seeks treatment.4 This lesion is not encapsulated, thus promoting significant infiltration into the adjacent medullar bone. In addition, this condition carries a high recurrence rate. The treatment of choice for this condition is surgical excision by either enucleation, curettage, or block resection.5 The average recurrence rate is 25%, especially when more conservative treatments are used.1,6 Cryotherapy has been used in the maxillofacial region for the removal of neoplasias or abnormal cell elements with no need for extensive segmental resection.7–9 Liquid nitrogen is the most efficient type of freezing spray available for bone cryosurgery.10 The most commonly observed complications associated with cryotherapy are pathologic fractures7,10,11 and bone sequestra.7,10 This paper reports the case of a recurrent mandibular myxoma diagnosed 30 years after the initial lesion treatment, and discusses the possibility of conservative management of extensive odontogenic lesions with high recurrence rates.

Osteochondroma of the temporomandibular joint: a case report

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Analgesic and adjuvant anesthetic effect of submucosal tramadol after mandibular third molar surgery

OBJECTIVE The aim of this study was to assess analgesic and adjuvant anesthetic effects of submucosal tramadol after third molar extraction. STUDY DESIGN In this double-blind, split-mouth, placebo-controlled, single-dose, crossover investigation, 52 patients underwent mandibular third molar extraction under local anesthesia. Surgical side was randomly assigned to submucosal 2 mL 100 mg tramadol injection (group T) or normal saline solution (group P) immediately after surgery. Anesthetic blockade duration, time of intake and amount of analgesic rescue drug, and postoperative pain intensity were recorded immediately after anesthesia cessation and 4, 8, 24, 48, and 72 hours after surgery. Data were submitted to analysis of variance and Wilcoxon tests. RESULTS Anesthetic blockade duration between groups was similar. Group T took significantly less rescue drug after 72 hours (P = .008). Time elapsed before first intake of rescue drug was longer (P = .006), and pain intensity was significantly lower (P = .001) in group T. CONCLUSIONS Submucosal tramadol injection after oral surgery improved postoperative analgesia, but did not extend anesthetic action duration.

Odontogenic Myxoma in a Child treated with enucleation and curettage

Odontogenic myxoma is an aggressive benign odontogenic tumor, accounting for 3-6% of all the odontogenic tumors in adults. The incidence among children is lower. Due to its clinical behavior, there is no consensus on the best treatment. In this paper, the authors report the case of a 9-year-old girl with the diagnosis of odontogenic myxoma. The panoramic X-ray showed an extensive radiolucent lesion involving the left mandibular body causing teeth displacement. The treatment consisted of tumor enucleation followed by vigorous curettage of the bone walls. Both the base of the mandible and the inferior alveolar nerve were preserved. The patient is asymptomatic after 6 months of surgery. The age of the patient and the radiographic features were taken into account when deciding in favor of the conservative treatment.