Rafael Linard Avelar

Odontogenic tumors: clinical and pathology study of 238 cases

UNLABELLED Odontogenic tumors are neoplasms that develops exclusively in the gnathic bones; they originate from odontogenic tissues, by epithelial or mesenchymal proliferation, or both. AIM To evaluate the incidence of odontogenic tumors in a specific institution, and to compare these findings with other studies in the literature. STUDY FORMAT: A cross-sectional cohort retrospective study. MATERIAL AND METHOD The sample was obtained from the files of patients with odontogenic tumors diagnosed between January 1992 and March 2007 (15 years). Cases in which the diagnosis could be adapted to the new World Health Organization (WHO) of 2005 were included. Data such as gender, age, anatomical site, histological type and symptomatology were analyzed. RESULTS Odontogenic tumors were 4.76% of all biopsied lesions within the studied period. The mean age was 30.7 years; 57% of the patients were male. The keratocystic odontogenic tumor was the most prevalent histological type (30%), followed by the ameloblastoma (23,7%). The rate of asymptomatic cases was 75.7%. CONCLUSION Odontogenic tumors occurred more frequently in females, in the second and third decades of life, and more commonly in the mandible; most cases were asymptomatic.

Tumores odontogênicos: estudo clínico-patológico de 238 casos

Os tumores odontogenicos sao neoplasias que se desenvolvem exclusivamente nos ossos gnaticos, originando-se dos tecidos odontogenicos por proliferacao de tecido epitelial, mesenquimal ou ambos. OBJETIVO: Avaliar a incidencia de tumores odontogenicos em determinada instituicao e comparar com outros estudos da literatura mundial. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E METODO: O material do estudo foi levantado a partir dos registros de pacientes com tumores odontogenicos, no periodo de janeiro de 1992 a marco de 2007 (15 anos). Foram incluidos os casos de pacientes que se enquadravam na Classificacao Histologica da Organizacao Mundial de Saude (OMS) de 2005. Foram analisados os indicadores genero, faixa etaria, localizacao anatomica, tipo histologico e presenca de sintomatologia. RESULTADOS: Os tumores odontogenicos constituiram 4,76% dentre todas as lesoes biopsiadas dentro do periodo estudado. A idade media dos pacientes foi de 30,7 anos, 57% dos pacientes eram do genero masculino. O tumor odontogenico ceratocistico foi o tipo histologico mais prevalente (30%), seguido do ameloblastoma (23,7%). Quanto a presenca de sintomatologia, 75,7% dos casos apresentaram-se assintomaticos. CONCLUSAO: Os tumores odontogenicos parecem ter discreta predilecao pelo genero feminino, segunda e terceira decadas de vida, sendo mais frequentes na mandibula e, na maioria dos casos apresentam-se assintomaticos.

Use of zoledronic acid in the treatment of Gorham's disease

Gorhams disease (Gorham-Stout syndrome) is a rare condition of unknown etiology involving a localized endothelial proliferation of lymph vessels resulting in destruction with bone resorption. The syndrome is rarely seen in the facial skeleton and has a large variety of prognoses and treatments. A case of this syndrome in a 9-year-old boy is presented. The clinical aspects are described, together with the treatment involving zoledronic acid. Other treatments described in the literature are reviewed. The authors believe that this report is one of the first cases in which a child afflicted in the first decade of life survives.

Pharyngeal Airway Changes in Class III Patients Treated With Double Jaw Orthognathic Surgery—Maxillary Advancement and Mandibular Setback

PURPOSE The pharyngeal airway may change after skeletal movement in patients who have undergone orthognathic surgery. The aim of this study was to evaluate the skeletal and pharyngeal airway changes in subjects with a Class III facial pattern who underwent double-jaw surgery (maxillary advancement and mandibular setback). MATERIALS AND METHODS The present retrospective study assessed preoperative (T0), 2- to 4-month postoperative (T1), and 6- to 12-month postoperative (T2) radiographs of subjects with a Class III facial pattern treated at São Lucas Hospital (Porto Alegre, Brazil) using imaging software (Dolphin Imaging 3D 11.5). Five measurements of the pharyngeal airway space (nasopharynx; upper, middle, and lower oropharynges; hypopharynx) were evaluated and correlated with the skeletal movement of the jaws (lines perpendicular to the Frankfurt horizontal plane passing through the nasion point to points A and B). The Student t test for paired samples was used to assess the presence of significant differences between the intervals, and the Spearman correlation coefficient was used to assess the significant correlation existing between the skeletal movement and the pharyngeal airway changes. The results were considered at a maximum level of significance of 5% (P < .05). RESULTS In the sample of 58 subjects (38 female and 20 male, 18 to 48 years old), measurements of the nasopharynx, upper oropharynx, and middle oropharynx increased, whereas measurements of the lower oropharynx and hypopharynx decreased during these periods (T0 to T1, T0 to T2). Decreases from T1 to T2 in the measurements of the nasopharynx and upper oropharynx were also identified. A correlation between the jaw movements and the change in airway measurement was found between the line perpendicular to the Frankfurt horizontal plane passing through the nasion point to point A and the nasopharynx and between the line perpendicular to the Frankfurt horizontal plane passing through the nasion point to point B and the lower oropharynx for T0 to T1 and T0 to T2. CONCLUSIONS A correlation between skeletal movements and changes in the measurements of pharyngeal airway was found between maxillary advancement and the nasopharynx, with proportions of 102.8% and 85.5% in the short and medium terms, respectively, and between mandibular setback and the low oropharynx, with proportions of 44.8% and 43.5% in the short and medium terms. A correlation for pharyngeal airway measurements was found between those located anatomically near each other, showing the importance of the pharyngeal muscles in this relation.

Use of autologous fat graft for correction of facial asymmetry stemming from Parry-Romberg syndrome.

Facial hemiatrophy is a typical manifestation of Parry-Romberg syndrome, characterized by a slow progressive atrophy that appears in early stages of life, primarily affecting the subcutaneous tissue and subjacent fat on 1 side of the face. We describe the case of a 42-year-old female patient with stabilized moderate facial hemiatrophy on the left side of the face, successfully treated with a 2-stage autologous fat transplant and the use of subcutaneous tunnels among the musculature for the placement of the graft. We also describe the principal forms of correcting facial asymmetry in patients with Parry-Romberg syndrome and demonstrate that an autologous fat graft provides good results in the correction of this deformity, with improved esthetics and patient satisfaction.

Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery.

In orthognathic surgery, Le Fort I osteotomy is one of the most often used methods for the correction of dental-facial deformities and is considered technically safe. However, this procedure may lead to diverse complications, including uncommon vascular complications. A clinical case is described of late development of pseudoaneurysm in one of the branches of the maxillary artery in a 20-year-old patient who had undergone Le Fort I osteotomy, bilateral sagittal osteotomy of mandibular branch, and mentoplasty and subsequently treated with embolization. The main forms of treating vascular injuries are reviewed, and embolization is demonstrated to be a technically safe procedure with few complications.

Assessment of the oral and maxillofacial surgery service in a teaching hospital in Brazil.

Objective:The purpose of this study was to determine an epidemiologic profile of the patients hospitalized and/or operated on by an oral and maxillofacial surgery service in Brazil. Materials and Methods:A retrospective and descriptive epidemiologic survey of the Oral and Maxillofacial Surgery Service from Saint Lucas Hospital at the Pontifical Catholic University, Porto Alegre, Brazil, from January 2000 to December 2005, was performed. Data related to the number, sex, age, service year, as well as surgical modalities performed, instituted treatments, and length of stay, were collected from the hospitals handbooks. Results:A total of 1117 patients were attended during the 6 years of study, with a decreasing tendency throughout the years (P = 0.022). There was female predominance (54%), between 10 and 40 years old, and attended via public health system (56%). Among surgical modalities performed, dentoalveolar surgery was the most prevalent (22.9%), followed by the orthognathic surgeries (21.4%), facial fractures (18%), pathologic condition surgeries (16.7%), and dental implants and grafts (13.7%). Surgeries of patients with cleft lip and/or palate (3.4%), treatment of maxillofacial infections (2.95%), and temporomandibular joint surgeries (1%) were less frequent. Conclusions:The information presented in this research elicited data to clarify the type of attendance performed by the service, being a cornerstone for planning, organization, and attention improvement of these patients. In addition, this information can compare with data among services, specialty acting fields, as well as, its impact in hospital activities.

Extensive cervical necrotizing fasciitis of odontogenic origin.

Necrotizing fasciitis (NF) is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of necrotizing fasciitis from odontogenic origin in a patient with uncontrolled diabetes mellitus. The initial diagnosis was based on clinical information, in which multiple necrosis areas in cervical and thoracic regions were observed. Wide antibiotic therapy was applied, followed by surgical drain age and debridement. Culture was positive for methicillin-resistant Staphylococcus aureus. Although the treatment is established, the patient dies after sepsis and failure of vital organs. Clearly, the morbidity associated to this infection, even in diabetic patients, can be minimized if an early diagnosis and effective debridement are done.

Horizontal maxillary osteotomy approach for resection of juvenile nasopharyngeal angiofibroma.

Juvenile angiofibroma is a benign fibroangiomatous tumor of relatively rare occurrence, developing most frequently in male adolescents. It has local characteristics of aggressiveness and expansion. The treatment of choice is surgical excision. In this article, the advantages and disadvantages of the surgical technique using the Le Fort I osteotomy are described, and the literature correlated with 2 case reports.

Effect of partially selective cyclooxygenase-2 inhibitor in the removal of third molars.

AbstractA randomized, double-blind clinical trial was carried out involving 25 patients scheduled for the removal of symmetrically positioned lower third molars in separate procedures. Either 100 mg of nimesulide or 7.5 mg of meloxicam was administered 1 hour before surgery and every 12 hours after surgery for 2 days. Evaluations were carried out in the preoperative period as well as on the second and seventh days after surgery. Objective and subjective parameters were recorded for comparison purposes. The patients having received nimesulide had less of a need for additional pain medication in the first 48 hours and had lower pain scale values (P < 0.05). There was less trismus in the meloxicam group (P > 0.05). Postoperative swelling was lower in the nimesulide group (P < 0.05). All measurements on the second day were lower in the nimesulide group (P < 0.001), and only one of these parameters was lower on the seventh day in the nimesulide group, distance from the lower edge of the tragus to the lip commissure on the operated side (P = 0.009, P < 0.001) compared with another group. Nimesulide proved effective in controlling pain and swelling after surgical removal of the lower third molars, with few adverse effects. Meloxicam proved effective in diminishing trismus.