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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2007. Vol. 12, no. 2
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- Apical seal comparison of low-temperature thermoplasticized gutta-percha technique and lateral condensation with two different master cones(2007) Pérez Heredia, Mercedes; Clavero González, Javier; Ferrer Luque, Carmen María; González Rodríguez, Mª PalomaObjetivo: comparar el sellado apical en conductos mesio-vestibulares de molares obturados con gutapercha termoplastificada a baja temperatura o con técnica de condensación lateral usando un cono maestro de gutapercha de conicidad .06 o .02. Como objetivo secundario se evaluó la penetración del espaciador en los conductos cuando se utilizó un cono de conicidad .02 o .06. Metodología: cuarenta y cuatro conductos mesio-vestibulares curvos (25-40º) fueron preparados con instrumentos rotatorios del niquel-titanio de conicidad .06 y distribuidos aleatoriamente en dos grupos control (n=4) y tres grupos experimentales (n=12) para obturarlos con el sistema Ultrafil® 3D o técnica de condensación lateral de gutapercha en frío con conos maestros de conicidad .06 o.02. AH-Plus fue utilizado como cemento sellador. La profundidad de penetración del espaciador fue registrada en milímetros. Las raíces fueron cubiertas con dos capas de barniz de uñas, sumergidas en tinta china durante 7 días, seccionadas transversalmente y examinadas con un estereomicroscopio. Para determinar si existían diferencias en la penetración del espaciador entre grupos se utilizó el test de la T de Student. La prueba de Kruskal-Wallis fue utilizada para determinar si existían diferencias en la penetración del tinte. Resultados: no hubo diferencias en la microfiltración entre los tres grupos de estudio (p= 0.396), que mostraban una media muy similar (0.42. 0.75 y 0.42). La comparación de la profundidad de penetración del espaciador en los grupos obturados mediante condensación lateral fue significativamente superior cuando se usó un cono de conicidad .02 (p= 0.001). Conclusión: el sistema Ultrafil®3D y la técnica de condensación lateral de la gutapercha con conos maestros de conicidad .06 o .02 fueron igualmente eficaces en el sellado apical de conductos curvos. El espaciador penetró en el conducto significativamente más cuando se empleó un cono de conicidad .02.
- Cavernous sinus metastasis from oropharyngeal squamous cell carcinoma(2007) González García, R.; Sastre Pérez, Jesús; Naval Gias, Luis; Rodríguez Campo, Francisco José; Díaz González, F.J.Metastasis to the cavernous sinus from head and neck cancer is uncommon and has been previously reported by a few authors. It is usually a late manifestation of the primary tumor and may be the first evidence of a widespread dissemination of the disease. Main clinical findings are those related with involvement of cranial nerves III to VI as they pass through the cavernous sinus. Although diagnosis may be difficult, the appearance of clinical and radiological findings of cavernous sinus involvement in a context of head and neck cancer must alert us about an intracranial metastatic infiltration. In most cases treatment is palliative with radiotherapy and/or chemotherapy. The prognosis of this entity is poor, with survival of a few months. We present the case of cavernous sinus metastasis from oropharyngeal squamous cell carcinoma and review the literature about the clinical presentation and management of this rare entity.
- Temporomandibular juxtaarticular chondroma : case report(2007) Vázquez Mahía, I.; López-Cedrún Cembranos, José Luis; Ferreras Granado, José; Lorenzo Franco, FernandaChondromas are benign tumours composed of mature hyaline cartilage. We present here the first case in the English language medical literature of juxtaarticular chondroma of the temporomandibular joint in the parotid region. Within the rarity of cartilage disorders of the temporo-mandibular joint (TMJ), this particular condition is a diagnostic curiosity. The patient, a 54 year old woman, presented a right preauricular tumour of 3.5 cm. which had been developing for 4 years. It was not painful but there was a recent symptomology of TMJ dysfunction, with pain and clicks. The diagnostic possibilities of a parotid pleomorphic adenoma and of a cartilage tumour of the TMJ suggested a difficult preoperative differential diagnosis, which influenced our approach regarding therapy. The tumour was excised, preserving the parotid gland. This enabled us to confirm the histological diagnosis of chondroma, composed solely of chondroide tissue. We have described the clinical characteristics of our case, and carried out a review of the relevant literature, emphasising the differential diagnoses.
- Facial nerve injury following surgery for the treatment of ankylosis of the temporomandibular joint(2007) Bessa-Nogueira, Ricardo Viana; Vasconcelos, Belmiro CavalcantiObjective: The purpose of the present paper was to carry out a longitudinal study of a series of cases in which injury of the facial nerve was observed following surgery for the treatment of temporomandibular ankylosis. Study design: The sample was composed of 13 patients, both male and female, in whom 18 surgical approaches were made. A postoperative assessment of the motor function of the facial nerve was made in accordance with the HouseBrackmann grading system. All the patients were photographed and assessed at the following postoperative times: 24 hours, one week, one month and three months. Results: The results showed that injury of the facial nerve occurred in 31% of the cases. An increase in the frequency of nerve injury was observed in the cases in which the interpositional arthroplasty technique was employed, as well as the fact that 75% of the patients had undergone at least one surgical intervention prior to the study. After three months all the patients displayed normal function of the facial nerve. Conclusion: The frequency of facial nerve injury is related to the degree of difficulty involved in the surgery determined by the type of ankylosis. The nerve lesions were shown to be of a temporary nature.
- Odontogenic calcificant cystic tumor : a report of two clinical cases(2007) Reyes Court, Daniel; Villanueva, Julio; Espinosa, Sebastián; Cornejo, MarcoOdontogenic Calcificant Cystic Tumor (OCCT) is an infrequent injury. It arises from odontogenic epithelial rests present in the maxilla, jaw or gum. Gorlin and col. described the OCCT for first time as an own pathological entity in 1962. Clinically, the OCCT represents 1% of the odontogenic injuries. It is possible to be found from the first decade to the eighth decade. It affects in same proportion the maxilla and the jaw, being the most common in the dented zones, with greater incidence in the first molar area. Two case reports of OCCT in two different ages, both in female individuals, one at 5 years old and the other at 35 years old are presented. Enucleation of the tumor was the treatment chosen. The purpose of this article is to present a review of the literature related to these two cases of OCCT and its treatment, putting an emphasis on its aetiology, biological behaviour and treatment.
- Positional vertigo afterwards maxillary dental implant surgery with bone regeneration(2007) Rodríguez Gutiérrez, Carlos; Rodríguez Gómez, EnriqueBenign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. It is caused by loose otoconia from the utricle which, in certain positions, displaced the cupula of the posterior semicircular canal. BPPV most often is a result of aging. It also can occur after a blow to the head. Less common causes include a prolonged positioning on the back (supine) during some surgical procedures. Additionally one can include in this ethiopathogenesis the positioning required during the maxillary dental implant surgery with bone regeneration related to a forced head positioning and inner ear trauma induced by dental turbine noise working in the maxillary bone. Two cases of patients who suffered BPPV after undergoing maxillary dental implant with bone regeneration procedures are reported. Diagnosis and treatment are also described.
- Langerhans cell histiocytosis in the maxillofacial area in adults : report of three cases(2007) García de Marcos, J.A.; Dean Ferrer, Alicia; Alamillos Granados, Francisco; Ruiz Masera, J.J.; Barrios Sánchez, G.; Romero Ortiz, Ana; Calderón Bohórquez, J.M.; Valenzuela Salas, B.Langerhans cell histiocytosis (LCH) is a disease of unknown etiology, characterized by proliferation of pathological Langerhans cells within different organs. It mainly affects children, but adult cases also occur, with an incidence rate of one to two per million. The head and neck are affected in almost 90% of cases. Diagnosis is made by means of histopathological analysis, and imaging studies are necessary in order to determine extent of the disease. There are no controlled trials proposing an optimal treatment protocol for LCH. Prognosis in adults is generally good due to the slow evolution of the disease and its favourable response to treatment. In our report, we present three cases of LCH in patients aged 16, 24, and 28 years respectively, with primary manifestation in the maxillofacial area. A literature review was also conducted.
- Management of odontogenic infection of pulpal and periodontal origin(2007) López Píriz, Roberto; Aguilar Alfaro, Lorenzo; Giménez Prats, María JoséThe dental biofilm is a complex bacterial ecosystem that undergoes evolution, maturing and development, and thus leads to odontogenic infection. The infection is normally located in the tissues of the dental organ itself, and follows a chronic course of evolution. However, bacterial pathogens express virulence factors in the biofilm, and this together with changes in host immunity, may cause clinical exacerbations and spread of infection to other areas of the body. Odontogenic infection management should take into consideration the fact that therapeutic success lies in the control of the infectious aetiologic agent, using mechanical-surgical debridement and/or antimicrobial therapy. Debridement techniques have a fundamentally quantitative effect (by reducing the size of the inoculum) and therefore if these techniques are used alone to control infection, despite an initial clinical improvement that is sometimes prematurely considered as therapeutic success, odontopathogens may persist and the process may recur or become chronic. Microbiological examination may be helpful in defining therapeutic success in a more reliable way, it could define the prognosis of recurrence more precisely, and could enable the most appropriate antibiotic to be selected, thus increasing therapeutic efficacy. Antimicrobial therapy brings about a quantitative and qualitative change in the bacterial composition of the biofilm, in addition to being able to act on sites that are inaccessible through mechanical debridement. However, incorrect antimicrobial use can lead to a selection of resistant bacterial species in the biofilm, in addition to side effects and ecological alterations in the host. In order to minimise this risk, and obtain maximum antimicrobial effect, we need to know in which clinical situations their use is indicated, and the efficacy of different antibiotics with regard to bacteria isolated in odontogenic infection.
- Tonsillolith : a report of three clinical cases(2007) Moura, Mariela Dura Gontijo de; Madureira, Davidson Fróis; Noman Ferreira, Luiz Cláudio; Abdo, Evandro Neves; Aguiar, Evandro Guimarães de; Freire, Addah Regina da SilvaTonsillolith is a rare dystrophic calcification as a result of chronic inflammation of the tonsils. Three asymptomatic cases of tonsillolith are reported, incidentally discovered through panoramic radiographs, which showed different sizes of radiopaque images, varying from 2 to 5mm; cases I and III images did not overlap the mandible ramus, which led to a probable diagnosis of soft tissue calcification. Case II had radiopaque unilateral images, with osseous tissue density, overlapping the mandibular ramus, leading to a benign intra-osseous lesion, which was considered as differential diagnosis. No symptoms were reported in any case. Only case I had clinical characteristics, showing highly consistent white plaques partially visible through the mucosa. Computed tomography of the maxillofacial region/head and neck were requested to find out the exact location of these images, since most of the overlapping radiopaque images in the mandibular ramus were very similar to intra-osseous abnormalities. The computed tomography showed hyperdense images in the palatine tonsils, confirming the diagnosis of tonsillolith. The patients are currently under follow-up. No treatment is required if there is no symptom. In conclusion, tonsillolith might show images on panoramic radiographs similar to intra osseous abnormalities. The diagnosis is relatively easy when computed tomography is requested, although the images are not pathognomonic. Therefore, clinicians should consider other pathologies as differential diagnosis.
- An observational study of the frequency of supernumerary teeth in a population of 2000 patients(2007) Leco Berrocal, María Isabel; Martín Morales, José F.; Martínez González, José MaríaObjectives.- An evaluation is made of the epidemiological characteristics of supernumerary teeth, with an analysis of the associated clinical-eruptive complications. Study design.- A longitudinal observational study was made of 2000 patients, with the documentation of demographic data, the presence of supernumerary teeth, their location, mechanical accidents and the presence of associated pathology. Results.- The presence of supernumerary teeth was recorded in 1.05% of the study subjects (mean age 20.2 years), with a greater frequency in males. The most frequent location was in the upper maxilla (79.2%), fundamentally in the retromolar zone and at premaxillary level. The presence of mechanical accidents was the most frequent complication (54%) ? the displacement of adjacent teeth being the most common finding ? along with the presence of follicular cysts. Conclusions.- The prevalence of supernumerary teeth in our series was 1.05%, the most frequent location being at upper distomolar level. Mechanical accidents were the most frequent complication.
- Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars(2007) Sierra Rebolledo, Alejandro; Delgado Molina, Esther; Berini Aytés, Leonardo; Gay Escoda, CosmeBackground: A comparative study is made of the anesthetic efficacy of 4% articaine versus 2% lidocaine, both with epinephrine 1:100,000, in truncal block of the inferior alveolar nerve during the surgical extraction of impacted lower third molars. Study design: A randomized double-blind clinical trial was conducted of 30 patients programmed for the bilateral surgical extraction of symmetrical lower third molars in the context of the Master of Oral Surgery and Implantology (University of Barcelona, Barcelona, Spain). Following the obtainment of informed consent, two operators performed surgery on an extemporaneous basis, using as local anesthetic 4% articaine or 2% lidocaine with the same concentration of vasoconstrictor (epinephrine 1:100,000). The study variables for each anesthetic were: latency (time to action) and duration of anesthetic effect, the amount of anesthetic solution used, and the need of re-anesthetize the surgical zone. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. Results: Statistically significant differences (p = 0.003) were observed in the mean duration of anesthetic effect (220.86 min. for 4% articaine vs. 168.20 min. for 2% lidocaine). Latency, the amount of anesthetic solution and the need to re-anesthetize the surgical field showed clinical differences in favor of articaine, though statistical significance was not reached. The pain scores indicated similar anesthetic efficacy with both solutions. Conclusions: The results obtained suggest that 4% articaine offers better clinical performance than 2% lidocaine, particularly in terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions.
- A mobilization regimen to prevent mandibular hypomobility in irradiated patients : an analysis and comparison of two techniques(2007) Grandi, Gisela; Silva, Miguel Luciano; Streit, Carla; Wagner, João Carlos B.Radiotherapy, when used in head and neck cancer treatment, can produce side effects in the patients, such as decreased salivary production, xerostomia, opportunistic infections, radiation caries, dysphagia, local discomfort and the limitation of mouth opening. The aim of this study was to evaluate the amplitude of mouth opening in patients before and immediately after the completion of radiotherapy, comparing the effectiveness of two physiotherapy exercises. The irradiated sites included the masticatory muscles. The results demonstrated that there were no statistically significant differences between the two instituted exercises; however there was a trend towards better clinical results in group 2. The amplitude of mouth opening showed a trend towards reduction, but this was not statistically significant. When the pterygoid and sternocleidomatoid muscles were included in the irriated field, patients were observed to have more morbidity. This indicates the great importance of these muscles in mouth opening. Based on the results obtained within this study, it is not possible to conclude that physiotherapy exercies are efficacious in preventing trismus. Future longitudinal studies are required to verify the onset of trismus in radiotherapy patients.
- Angiomyolipoma of the upper lip : case report and review of the literature(2007) Silva, Andréia Aparecida da; Carlos, Román; Contreras Vidaurre, Elisa; Almeida, Oslei Paes de; Lopes, Márcio Ajudarte; Vargas, Pablo AgustínAngiomyolipoma (AML) is a hamartomatous growth that usually affects the kidney. One third of patients with AML present with manifestations of tuberous sclerosis. Oral AML is rare with only 6 cases reported in the English-language literature. In the present case, AML was located in the upper lip of a 43 year-old woman. Clinically, it presented as a firm nodule, well circumscribed and measuring 1x2 cm. It was surgically excised. Histopathological analysis showed a lesion composed of an admixture of smooth muscle cells, blood vessels, and adipose tissue. The immunohistochemical study revealed positivity for vimentin, smooth muscle actin, pan specific muscle actin and desmin. CD68, CD34 and mast cell antibodies showed focal immunoreactivity. S100 protein, Ki-67, and HMB-45 were negative. Based on these histological and immunohistochemical features the diagnosis was of oral AML. No recurrence was observed after 2 years of follow-up.
- Oral rehabilitation with the new SG® attachment in a patient treated for oral squamous cell carcinoma(2007) Senent Vicente, Gisela; Barjau Guiñon, Ignacio; Silvestre Donat, Francisco JavierIn patients who have undergone surgery and radiotherapy for oral squamous cell carcinoma (OSCC), the posterior oral rehabilitation may prove complex. In addition to the defects produced by surgical ablation of the primary tumor, radiotherapy induces deleterious effects upon the oral tissues. We present the case of a 48-year-old male treated two years before due to OSCC in the retromolar trigone and left lateral wall of the oropharynx. Following study of the case with clinical examination and orthopantomography, a management plan was defined involving rehabilitation of the upper dental arch with fixed ceramometallic prostheses, while in the lower arch we chose a unilateral removable prosthesis adapted to a fixed prosthesis by means of a special and versatile attachment based on a new system that functions as a fixed element but which can be removed or changed at some later date. The present clinical case illustrates this type of prosthodontic solution for the management of oncological patients of this kind.
- Attitude towards oral biopsy among general dentists in Murcia(2007) López Jornet, María Pía; Velandrino Nicolás, Antonio Pablo; Martínez Beneyto, Yolanda; Fernández Soria, MercedesObjective: The present study explores the attitude of general dentists towards oral biopsy as a diagnostic method in application to oral lesions. Material and methods: A questionnaire was administered by mail to 520 general dentists in the Autonomous Community of Murcia (Spain), addressing a number of items: sociodemographic parameters, years of professional experience, the diagnosis of mucosal lesions, the performance of oral biopsies, and their histopathological evaluation. Results: The global response rate was 32.7% (55.9% for males and 43.5% for females), with a global mean age of 35.9 years. Of note is the fact that the group with least professional experience did not include oral biopsy as diagnostic procedure, with statistically significant differences versus the other groups of experience (p=0.048) Conclusion: The assimilation of oral biopsy as a diagnostic procedure is seen to increase with the number of years of professional experience.
- Myoepithelial cells are the main component in pleomorphic adenomas?(2007) Ponce Bravo, Santa; Ledesma Montes, Constantino; López Becerril, Uriel; Morales-Sanchez, IsraelObjetivo: El objetivo de este estudio fue cuantificar por medio de inmunohistoquí-mica el número de células mioepiteliales (CMs) en adenomas pleomorfos (APs). Mate-rial y Métodos: Se recuperaron los cubos de 27 APs y se hicieron nuevas laminillas, las que se tiñeron con un anticuerpo anti-proteína S-100, se contó el número de células S-100 positivas, se registró su morfología y se hicieron comparaciones del número de CMs tomando en cuenta el sexo, edad y glándula de origen. Resultados: Se observó que en el tejido glandular normal, las CMs solo se observaron alrededor de las estructuras ductuales. En los APs analizados se encontró que en promedio, solamente el 27,4% de las células neoplásicas fueron positivas a este anticuerpo. Con excepción de un AP, en todos los casos analizados las células plasmocitoides fueron las células más comúnmente encontradas (48,6%). Conclusiones: Los resultados de este estudio su-gieren que las CMs no forman el componente celular principal del compartimiento neo-plásico de los APs y confirman las evidencias encontradas desde hace varios años, por diferentes autores, quienes estudiando los APs, sugirieron que las CMs no forman la mayor parte de las células neoplásicas en estas entidades.
- Tensor tympani muscle: strange chewing muscle(2007) Ramírez, Luis Miguel; Ballesteros, Luis Ernesto; Sandoval, Germán PabloThis work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for detecting different pathologies? common otic symptoms. It offers better tools for this shared symptomatology during therapy?s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the stomatognathic system; these muscles? increased tonicity ceases to be a phenomenon having no logical connections. It offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline from a broad, anatomical and clinical perspective.
- Oral pathology in a group of Mexican patients with genetic diseases(2007) Montoya Pérez, Luis A.; Arenas Sordo, María de la Luz; Hernández Zamora, Edgar; Aldape Barrios, B.Dejando de lado la patología infecciosa y traumática, la gran mayoría de las patologías odontológicas, tienen una base genética, en algunas de ellas identificada, en otras no. Para los estomatólogos es de gran importancia conocer las características clínicas y el tipo de alteración que acompañan a los síndromes de etiología genética, para poder ofrecer a los pacientes un tratamiento apropiado y multidisciplinario. Objetivo: Búsqueda intencional y descripción de la patología bucal en pacientes con diversas enfermedades genéticas. Diseño del estudio: Se realizó un estudio observacional y descriptivo reuniendo a 62 pacientes de la consulta de Genética del Instituto Nacional de Rehabilitación durante 4 meses. Se tomaron en cuenta, además de las manifestaciones bucales y la enfermedad genética relacionada a las mismas, el sexo, la edad, la presencia o no de consanguinidad, y endogamia, así como la localización de la manifestación bucal. La mayoría de los pacientes que presentan patología genética no tienen tratamiento curativo, pero sí podrán realizarse otros tratamientos para mejorar su calidad de vida, entre estos se cuentan los diversos tratamientos odontológicos. Resultados: Los padecimientos diagnosticados con mayor frecuencia fueron neuropatías periféricas hereditarias, displasias esqueléticas, malformaciones de miembros y distrofias musculares. Se describieron diversas manifestaciones que fueron registradas y agrupadas de acuerdo a su localización. Conclusiones: En la actualidad se busca conocer la etiología genética de todos los padecimientos para buscar tratamientos específicos y prevenir su aparición, hechos que revolucionarán la práctica médica y la odontológica.
- Odontogenic Cysts : analysis of 2.944 cases in Chile(2007) Ochsenius, Germán; Escobar, Enrico; Godoy, Luis; Peñafiel, CristiánIntroduction: Odontogenic cysts constitute a group of frequent intraosseous lesions characteristic in the maxillary bones and one of the main causes of the destruction of these bones. In Chile there are no retrospective studies of these lesions as a whole. Objective: The purpose of this study is to determine the frequency of these lesions in so far as they were diagnosed and registered in the Referral Institute for Oral Pathology (IREPO) of the University of Chile in two age groups as well as to analyze and to compare the data obtained with the data published in previous studies. Material and Method: We studied the records from IREPO of the University of Chile for the period between 1976 and September, 2004; and we determined the frequency according to age, gender and site of each of these lesions. We compare two age groups: younger than or equal to 15 years old and older than 15 years old. Those cases in which the information did not suffice for the purposes of analysis were not considered. All the histological slides were reclassiffed according to the diagnostic criteria included in the Histological Typification of the World Health Organization. Results: We found 2.944 odontogenic cysts (OC), of which 1.935 (65.7%) were inflammatory cysts and 1.009 were developmental cysts. Out of this total, there were 1.554 cysts (52.8%) in men and 1.390 (47.2%) in women. The most frequent cysts were 1.494 radicular cysts (50.7%), 546 dentigerous cysts (18.5%), 421 keratocysts (14.3%) and 328 residual cysts (11.1%). These four varieties represent 94.7% of the OC , that is, 2789 cases. In the population younger than or equal to 15 years of age the developmental cysts (354 cases) are more frequent than the inflammatory cysts (155 cases), the most frequent being dentigerous cysts (240 cases).
