Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2006. Vol. 11, no. 5

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    The rôle of saliva in maintaining oral health and as an aid to diagnosis
    (2006) Llena Puy, María Carmen
    La saliva es una secreción compleja proveniente de las glándulas salivales mayores en el 93% de su volumen y menores en el 7% restante. El 99% de la saliva es agua mientras que el 1% restante está constituido por moléculas orgánicas e inorgánicas. Si bien la cantidad de saliva es importante, también lo es la calidad de la misma. Se revisará los componentes de la saliva y sus funciones en el mantenimiento de la salud oral los principales factores causales que alteran la secreción salival, se comentará la importancia de la saliva en el desarrollo de la enfermedad de caries y en la formación de la placa bacteriana, y se analizará su papel como material de ayuda para el diagnóstico de algunas patologías. Las variaciones en el flujo salival pueden verse afectadas por múltiples factores fisiológicos y patológicos, de forma reversible o irreversible. Juega un papel fundamental en el mantenimiento de la integridad de las estructuras bucales, en la vida de relación, en la digestión y en el control de infecciones orales. El papel de la saliva en la protección frente a la caries podemos concretarlo en cuatro aspectos, dilución y eliminación de los azúcares y otros componentes, capacidad tampón, equilibrio entre la desmineralización / remineralización y acción antimicrobiana. La saliva como alternativa para el diagnóstico, de algunas enfermedades, como elemento para monitorizar la evolución de determinadas patologías o la dosificación de medicamentos o drogas proporciona una vía prometedora. La accesibilidad en su obtención y la correlación positiva entre múltiples parámetros en el suero y en la saliva son algunas de las ventajas que ofrece como instrumento diagnóstico.
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    Sebaceous adenoma of the parotid gland
    (2006) Vicente Rodríguez, Juan Carlos de; Fresno Forcelledo, Manuel Florentino; González García, Manuel; Aguilar Andrea, Carolina
    Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven.
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    Gigantic tongue lipoma : a case report
    (2006) Chidzonga, Midion Mapfumo; Mahomva, Leonard; Marimo, Clemence
    Lipomas are among the most common tumors of the human body. However, they are uncommon in the oral cavity. In the oral cavity they present as a slow growing, painless, and assymptomatic yellowish submucosal mass. Surgical excision is the treatment of choice with recurrence not expected. They have been known to grow to large sizes causing mastication and speech difficulties. The usual lesions consist of a well circumscribed, lobulated mass of mature fat cells. In other situations the covering mucosa becomes ulcerated and presents difficulties in diagnosis. The present report is of a patient who presented with a gigantic lipoma on the tip of the tongue which had been present for 3 years. She now had difficulty with speech and mastication as the tongue tumor now completely filled the oral cavity. An incision biopsy confirmed the tumor as lipoma. The tumor was surgically excised with restoration of normal tongue function, speech and masticatory capacity. Histopathologic examination of the excised tumor confirmed that it was a lipoma.
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    The use of methylprednisolone versus diclofenac in the treatment of inflammation and trismus after surgical removal of lower third molars
    (2006) López Carriches, Carmen; Martínez González, José María; Donado Rodríguez, Manuel
    Objective: To compare the efficacy of methylprednisolone (corticoid)versus diclofenac (nonsteroidal anti-inflammatory -NSAID-) in the treatment of inflammation and trismus after the surgical removal of lower third molars. Study design: Prospective study on 73 patients for the surgical removal of their lower third molars. These patients were separated in two groups at ramdom: the diclofenac group and the methylprednisolone group. A record card was filled in with preoperative and postoperative epidemiological and clinic data about inflammation and trismus (three facial measures and mouth opening). In order to make a broad study of data, BMDP program was used for statistics. Results: 24 hours after surgery, patients in the diclofenac group showed a more severe inflammation in one of the facial measurements (p<0.05). Trismus was very similar in both groups. Conclusions: There were no differences in trismus depending on the antiinflammatory used. Patients in the corticoid group showed less inflammation but the difference was not as important as to justify their use.
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    Glove perforation during oral surgical procedures
    (2006) Xavier, Ruth Lopes de Freitas; Vasconcelos, Belmiro Cavalcanti; Silva, Luiz Carlos F.; Porto, Gabriela Granja
    Objective: The aim of this study was to determine the incidence of glove perforation among undergraduates and residents performing maxillofacial surgery and identify procedures associated with the perforations. Study Design: For this purpose, 200 pairs of surgical gloves were used. For inspecting the perforations, the gloves were filled with water, at least 500 ml. Results: Sixteen gloves (8%) were perforated, 8 (4%) by residents and 8 (4%) by undergraduate students. Only the residents noticed that 2 gloves (1%) were perforated and identified the object causing the perforation. The left hand was the more affected with 9 perforations (4.5%). The finger pulp was the region most affected with 12 perforations (6%). The perforated forefinger appeared in 8 gloves (4%), representing the highest incidence of perforations. Conclusion: We concluded there was no difference in surgical glove perforation between undergraduate students and residents, the incidence of perforations was greater in the left hand (nondominant hand) and the fingers in which most perforations occurred were the forefinger and the thumb.
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    Granular cell tumor : report of 8 intraoral cases
    (2006) Eguía Del Valle, Asier; Uribarri Etxebarria, Agurne; Gay Escoda, Cosme; Crovetto de la Torre, Miguel Angel; Martínez Conde, Rafael; Aguirre Urízar, José Manuel
    Granular cell tumor (GCT) is an uncommon neoplasm of controversial origin that can appear in any corporal localization, including the orofacial region. Although aggressive and malignant variants of this neoplasm have been described, most of GCTs are benign. In spite of the amount of research, the etiology of this neoplasm remains unclear and its histogenesis and its possible muscular, conective or neural origin has been broadly debated. In this paper 8 oral cases are presented, corresponding to 5 women and 3 men, with a mean age of 36.1 years old and a mean time of evolution of the lesions of 8.3 months. The most common localization was the tongue (75%). In all the cases a resection with safety margins of the lesions was carried out under local anesthesia. The samples were fixed and processed for histopathological study. The main clinicopathologic and diagnostic features of this neoplasm are reviewed and discussed.
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    Update in dental implant periapical surgery
    (2006) Peñarrocha Diago, Miguel; Boronat López, Araceli; Lamas Pelayo, Joana
    La lesión periapical implantaria es una patología infecciosa-inflamatoria localizada alrededor del ápice del implante. Puede ser provocada por diversas causas, entre ellas: la contaminación en el momento de la instrumentación, el sobrecalentamiento óseo y la presencia de una patología preexistente en el hueso. Su diagnóstico es sintomático y radiográfico, y puede observarse una imagen radiolúcida alrededor del periápice. Clasificamos las lesiones según el momento evolutivo en lesión aguda (no supurada y supurada) y crónica o absceso periapical. El tratamiento de esta patología es la cirugía periapical con legrado e irrigación en la fase aguda; y la extracción del implante cuando se involucre la superficie ósea y/o se pierda la fijación primaria (fase crónica).
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    Oral manifestations of Cowden?s disease : presentation of a clinical case
    (2006) Segura Saint Gerons, Rafael; Ceballos Salobreña, Alejandro; Toro Rojas, Mariano; Gándara Rey, José Manuel
    Cowden?s disease, or multiple hamartoma syndrome, is an autosomal dominant genodermatosis, characterized by the presence of multiple cutaneous hamartomas, oral fibromas and benign acral keratosis. It affects multiple organs (breast, thyroids, stomach, colon), with the strong possibility of malignant neoplasia developing in these organs. We present a case of this rare syndrome, highlighting the presentation of some clinical characteristics that, in suspected cases, can help to establish an early diagnosis of this disease, this being of great importance given the high frequency of tumors in people with this clinical picture.
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    The relationship between the levels of salivary cortisol and the presence of xerostomia in menopausal women : a preliminary study
    (2006) Rivera Gómez, María Begoña; Hernández Vallejo, Gonzalo; Arriba de la Fuente, Lorenzo; López Cantor, Margarita; Díaz Rodríguez, Milagros; López-Pintor Muñoz, Rosa Mª
    Xerostomia is a particularly frequent occurrence among menopausal women, and is often associated with depression. Objectives: To evaluate the relationship between unstimulated salivary flow rate and the presence of xerostomia, and to determine the levels of salivary cortisol and its relationship with xerostomia. Study design: Thirty women were selected from patients attending the Department of Medicine and Buccofacial surgery, and formed into two groups, study and control. Samples of unstimulated salivary flow were collected, and the amounts of salivary cortisol determined using the ELISA technique (enzyme-linked immunosorbent assay). Results: The mean unstimulated salivary flow rates for the control and study group were 0.37 ± 0.28 ml/min and 0.24 ± 0.18 ml/min, respectively. The concentration of salivary cortisol was 3.47 ± 1.64 ng/ml for the control group and 2.29 ± 2.60 ng/ml for the study group. The statistical tests applied showed no significant differences for either variable between the two groups in the study. Conclusions: The results of the present study indicate that there is no relationship between variations in the rates of unstimulated salivary flow and the corresponding concentration of cortisol.
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    Computed tomography of the TMJ in diagnosis of ankylosis : two case reports
    (2006) Casanova, Marcia Spinelli; Tuji, Fabrício Mesquita; Ortega, Ana Isabel; Yoo, Hea Jung; Haiter Neto, Francisco
    Ankylosis of the temporomandibular joint is characterized by restriction or limitation of mandibular movement. It presents as a classic symptom a limited range of motion on opening. Radiographically, ankylosis presents features that facilitate the diagnosis. However, its visualization is not clear in most of the cases involving conventional radiographic techniques. With the evolution of radiographic techniques, computed tomography (CT) became an important examination in the diagnosis of the ankylosis of temporomandibular joint. Due to the increasing use of the CT and its importance in the diagnosis of this disease, the aim of this paper is to present and describe tomographic images of ankylosis of this joint by presenting two clinical cases, using several slices as axial, coronal, and three-dimensional reformatted images.
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    Adenoid cystic carcinoma of the dorsum of the tongue : presentation of a case
    (2006) Carrasco Ortiz, Dolores; Vallespín, Olga
    Adenoid cystic carcinoma is the most frequent malignant neoplasm of minor salivary glands (76.5%); it is clinically characterized by slow growth, and its most frequent localization is the hard palate. Histopathologically it presents three patterns, cribriform, tubular and solid; the solid type is related to a poor prognostic contrary to the cribriform type, which has a better prognosis. Surgical excision with wide margins is the treatment of choice, if it metastasizes to lymph nodules, post surgical radiotherapy is recommended. A 19 year-old man presented a recurrent lesion on the dorsum of the tongue previously diagnosed as monomorphic adenoma. In a second biopsy it was diagnosed as adenoid cystic carcinoma. The following immunohistochemical studies were ordered: CALP, CEA, Epithelial Membrane Antigen, Glial Fibrilar Acid Protein, Ki67; all of these studies were positive and with different intensities, corroborating the diagnosis of adenoid cystic carcinoma. The patient had a recurrence after 2 years.
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    Darier disease : case report with oral manifestations
    (2006) Cardoso, Camila Lopes; Freitas de Andrade, Patrícia; Taveira, Luís Antônio de Assis; Consolaro, Alberto
    Darier disease, also known as keratosis follicularis or dyskeratosis follicularis, is a rare autosomal dominant genodermatosis. It is clinically manifested by hyperkeratotic papules primarily affecting seborrheic areas on the head, neck and thorax, with less frequent involvement of the oral mucosa. When oral manifestations are present, they primarily affect the palatal and alveolar mucosa, are usually asymptomatic, and are discovered in routine dental examination. Histologically, the lesions present suprabasal clefts in the epithelium with acantholytic and dyskeratotic cells represented by corps ronds and corps grains. This paper reports a case of an adult male patient presenting clinical signs of Darier disease in the palatal mucosa and skin on the neck and upper limbs. Intraoral biopsy of the affected area, analysis of family history and evaluation by a multidisciplinary team led to the diagnosis of Darier disease. Dental professionals and pathologists should be aware of these lesions to allow correct diagnosis and proper management of this disease.
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    Spindle cell lipoma of the floor of the mouth : a case report
    (2006) Coimbra, Filipe; Lopes, J.M.; Figueiral, M. Helena; Scully, Crispian
    A sessile swelling in the floor of the mouth appeared three years ago in a 29-year old Caucasian female located laterally to the opening of the right duct of Wharton. The mass covered by normal looking mucosa exhibited slight growth since then. After excision, histological examination revealed the presence of a tumor formed by areas of mature adipose cells interspersed with extensions of tightly disposed fusiform fibroblasts immunoreactive for vimentin and CD-34. There were foci of concentric fibroblasts forming dense whorls. When large these conglomerates exhibited chondrocytes in the center. Mast-cells were not rare throughout the fibroblastic areas. No signs of malignancy occurred. These features led to the diagnosis of a spindle cell lipoma with chondrous metaplasia. The relative rarity of such a tumor in this location, especially in the chondrous variety, was considered worth of presentation, while the differential diagnosis with other intraoral tumors, namely mucoceles, dermoid cysts, mesenchimomas, fibromas and myxomas of the floor of the mouth, is discussed.
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    Bisphosphonates and Oral Pathology I : general and preventive aspects
    (2006) Ponte Fernández, N.; Estefanía Fresco, Ruth; Aguirre Urízar, José Manuel
    Los bisfosfonatos constituyen un grupo de fármacos capaces de modular el recambio óseo y disminuir su remodelado cuando existe una reabsorción excesiva. Por ello están indicados en numerosas patologías óseas como la osteoporosis postmenopáusica o la osteolisis asociada al cáncer de mama o al mieloma múltiple. En los últimos años y a raíz de su utilización masiva se han ido publicando numerosos casos de complicaciones asociadas a su uso. Entre los posibles efectos adversos más importantes se encuentran los orales, con la aparición de ulceraciones y sobre todo los casos de osteonecrosis de los maxilares asociados a esta terapéutica. En esta revisión analizamos las características generales de estos medicamentos y su mecanismo de actuación, así como los efectos adversos descritos, especialmente los orales y maxilofaciales, haciendo una referencia especial sobre la prevención de la osteonecrosis de los maxilares, a la luz de los casos descritos en la literatura médica y odontológica. El protocolo preventivo refuerza el papel fundamental del odontólogo en la prevención efectiva de este proceso antes, durante y después del tratamiento.