Marcos Antônio Torriani

Autogenous non-vascularized bone graft in segmental mandibular reconstruction: a systematic review

The restoration of mandibular bone defects with non-vascularized bone grafts depends on the diagnosis, anatomical site, extent of the defect, and the patients age, as well as the surgeons experience. The aim of this study was to perform a systematic literature review on mandibular reconstruction for segmental mandibular bone defects using non-vascularized bone grafts to answer the following question: Is there scientific evidence to support the use of this technique? The initial literature search in PubMed, Scopus, and Cochrane databases identified 862 articles. Of these, 25 were included in the final review. These articles encompassed 926 procedures with non-vascularized bone grafts; 76.1% were from the iliac crest. Benign tumours were the major cause of these defects (56.8%), and 44.7% of defects were located in the lateral mandibular area. Although this technique showed a high occurrence of complications (290 in 873 patients, some with more than one complication), these did not account for treatment failure. The restoration of bone defects due to malignant tumours treated with radiation therapy had lower success rates, and these appear to be a contraindication for the technique. Although standardized randomized controlled clinical studies are needed to obtain better clinical evidence for treatment choices in general, the use of non-vascularized bone grafts for mandibular reconstruction showed an 87.6% success rate in this review.

Modified Approach to Central Giant Cell Lesion

This case report discusses a modified technique for treatment of a central giant cell lesion (CGCL) in children, where a recontouring procedure is performed prior to the treatment with intra lesional corticosteroid. We discuss the advantages of this less invasive technique, specially considering the early age of the patient and its bone growth, as well as the conservative approach for lesions in those cases. The treatment of an 8-year-old female patient exhibiting CGCL in anterior region of mandible with bone expansion is described. The procedure was performed using blade #15 and rongeur forceps, in order to obtain an adequate jaw contour. Two weeks later, drug treatment started with triamcinolone 10mg/ml diluted in 0.5% bupivacaine without vasoconstrictor agent, 1:1 ratio, for eight sessions. There were no complications in surgery and postoperative period. In 3-year follow-up, anatomical preservation is present with no signs of recurrence.

An unusual wooden foreign body in the face: a case report

Although injuries with the presence of foreign bodies in the maxillofacial region are relativelyxa0common in urgency and emergency services, they still pose a diagnostic challenge that is relatedxa0to several factors, such as type of trauma, foreign body material, patient’s level of consciousnessxa0and anatomical site involved. A third of foreign bodies in the face are not detected upon initialxa0examination and may remain in deep tissues until they are accidentally encountered by imaging testsxa0for other purposes or until the patient shows symptoms such as pain or swelling. This article reportsxa0a case of a 9 cm piece of wood extracted from a patient’s middle third region of the left midfacexa0after 30 days of trauma occurrence, with associated infection suggesting a clinical picture ofxa0neoplasia.

Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review

This study aimed to answer the following question: What is the best treatment option for fractures of the dentate portion of the mandible in paediatric patients when considering the occurrence of postoperative complications? A systematic literature review was done using the PubMed, Scopus, and Cochrane Library databases, and 1186 articles on the topic were found. Twelve of these articles were included in the final review after the full texts had been read. A sample of 178 paediatric patients was obtained. In the six cases in which treatment was surgery with titanium plate fixation, there were no postoperative complications, whereas in the 141 cases in which treatment was surgery with biodegradable plates, there were 12 postoperative complications, and in the 31 cases in which treatment was non-surgical, there were three postoperative complications. A connection between the best treatment and the number of postoperative complications in fractures of the dentate portion of the mandible in paediatric patients could not be established; however, the occurrence of postoperative complications was low for both surgical and non-surgical treatments.

Keratoacanthoma in the cutaneous area of the upper lip: a case report

PURPOSE: The aim of this paper is to briefly review and discuss the literature about KA and present a case report with a 2-year follow-up of the removal of a KA lesion in the upper lip. CASE DESCRIPTION: A 53-year-old woman complained of a painless, aesthetically unpleasant brownish, hard lesion in the cutaneous area of the upper lip. The lesion had grown rapidly in the last 30 days (size: ~10×5 mm), and was associated with a hot waxing hair removal. Surgical excision was the treatment chosen in order to differentiate the lesion from squamous cell carcinoma (SCC). An oval-shaped incision was created with an in-depth wedge shape for the removal of the lesion and better approximation of the edges after synthesis. Histopathological analysis confirmed the diagnosis of KA. After 2 years, the patient was completely satisfied with the treatment, and no scar was evident. CONCLUSION: Due to the clinical difficulty in differentiating KA from SCC and the risk for formation of an aesthetically unpleasant scar upon spontaneous resolution of KA, surgical removal might be considered the treatment of choice for a solitary KA. OBJETIVO: O objetivo deste trabalho e revisar e discutir brevemente a literatura sobre CA e apresentar o relato de um caso da remocao de CA em labio superior com 2 anos de acompanhamento. DESCRICAO DO CASO: Mulher com 53 anos queixava-se de lesao indolor, esteticamente desagradavel, dura e de coloracao marrom na area cutânea do labio superior. A lesao havia crescido rapidamente nos ultimos 30 dias (tamanho: ~10×5 mm), e estava associada a remocao de pelos com cera quente. Excisao cirurgica foi o tratamento escolhido para diferenciar a lesao de carcinoma espinocelular (CEC). Uma incisao em forma oval aprofundada em forma de cunha foi realizada para remocao da lesao e melhor aproximacao das bordas apos a sintese. A analise histopatologica confirmou o diagnostico de CA. Apos 2 anos, a paciente estava completamente satisfeita com o tratamento, e nenhuma cicatriz era evidente. CONCLUSAO: Devido a dificuldade na diferenciacao clinica entre CA e CEC, e o risco de formacao de cicatriz esteticamente desagradavel quando da resolucao espontânea do CA, a remocao cirurgica pode ser considerada o tratamento de escolha para CA solitario.