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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2010. Vol. 15, no. 4
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- Treatment of masseteric hypertrophy with botulinum toxin : a report of two cases(2010) Bas, Burcu; Özan, Bora; Muglali, Mehtap; Celebi, NükhetMasseter muscle hypertrophy is a rare condition of unknown cause which is important in the differential diagnosis of head and neck masses, located in the cheek. Several treatment options reported for masseter hypertrophy, which range from simple pharmacotherapy to more invasive surgical reduction. Botulinum toxin type A is a powerful neurotoxin which is produced by the anaerobic organism Clostridium botulinum and when injected into a muscle causes interference with the neurotransmitter mechanism producing selective paralysis and subsequent atrophy of the muscle. Injection of botulinum toxin type A into the masseter muscle is generally considered a less invasive modality and has been advocated for cosmetic sculpting of the lower face. Botulinum toxin type A injection is considered to be a beneficial treatment modality in masseter muscle hypertrophy patients. The aim of this article is to report two cases of masseteric muscle hypertrophy which were treated with botulinum toxin type A injection. Marked changes in facial feature were achieved 3 months after the procedure.
- Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction(2010) Escoda Francolí, Jaume; Vázquez Delgado, Eduardo; Gay Escoda, CosmeAbstract Hyaluronic acid (HA) is found in high concentrations in cartilage and synovial fluid, and is an important component of the extracellular matrixes ? exerting joint lubrication and buffering actions thanks to its viscoelastic properties. The present study examines the scientific evidence found in the current literature on the usefulness of the intraarticular injection of HA in patients with temporomandibular dysfunction. A literature search was made up until May 2008 in the following databases: PubMed / MEDLINE. Of the articles found in the literature, the present review included 18 relevant studies on the application of HA in the temporomandibular joint (TMJ). The quality, level of evidence and strength of recommendation of the articles was evaluated based on the ?Strength of Recommendation Taxonomy? criteria. It is concluded that type A level of recommendation exists in favor of the intraarticular injection of HA in dysfunction of the TMJ. However, further studies are needed to establish the true therapeutic effects and to identify the best dosing regimen.
- Myofascial pain associated to trigger points : a literature review. Part 2: Differential diagnosis and treatment(2010) Vázquez Delgado, Eduardo; Cascos Romero, Jordi; Gay Escoda, CosmeDuring the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus required in order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment.
- The use of carrageenan for limiting the mandibular movement in rats : a preliminary experimental study(2010) Porto, Gabriela Granja; Cavalcanti do Egito Vasconcelos, Belmiro; Silva Junior, Valdemiro Amaro da; Andrade, Emanuel Sávio de SousaPurpose: The objective of this study was to evaluate if the carrageenan may be used for limiting the mandibular movement. Material and Methods: Eighteen adult male Wistar rats were used for the research, 20 µl of carrageenan (4%) was infiltrated in the extra articular region, in front of the condyle to induce fibrosis. The rats were divided into groups according to the time of euthanasia (7, 15 and 30 days). Maximal mouth opening (MMO), mandibular deviation, initial and final weights were recorded and evaluated. After the euthanasia, the specimens were submitted to histological study in order to classify the inflammatory process using scores. Results: The mean differences between initial and final MMO were 1.50 mm, being greatest at the 7 days evaluation and lowest at 30 days, and were not statistically significant at any time. No mandibular deviation was observed at any of the times of evaluation. The histological scores tended to increase with time of evaluation from 7 to 30 days, but without progression of the process. Conclusion: The study model permitted the development of fibrosis in the extra-articular region in the majority of the animals.
- Microstructure alterations of rotary files after multiple simulated operative procedures(2010) Luzi Luzi, Arlinda; Forner Navarro, Leopoldo; Almenar García, Amelia del Pilar; Llena Puy, María CarmenAim: To assess morphological alterations of ProTaper rotary NiTi files before and after continuous use by scanning electron microscopy (SEM). Study Design: 30 root canals were chosen with an angle between 15 and 30º. Before starting to prepare the canals the files were observed microscopically using a scanning electronic microscope. The ProTaper sequence recommended by the manufacturer was used, with NaOCl as irrigant. The instruments were sterilised after every three canals were shaped. The instruments were observed with the same microscope after shaping each canal, until 30 root canals were shaped. The criteria used for checking the instruments were: blunt cutting edges, disruption of cutting edge, microfractures, fatigue cracks, metal flash, dentine remains. Results: Many microscopic defects were found such as: cutting edge breaks (up to 70%); fatigue cracks, between 33 and 100%. No microfractures were found. An S1 and an SX file were fractured. Conclusion: ProTaper instruments are quite reliable if used following usual requirements.
- Efficacy and safety comparison of two amoxicillin administration schedules after third molar removal. A randomized, double-blind and controlled clinical trial(2010) Luaces Rey, Ramón; Arenaz Búa, Jorge; López-Cedrún Cembranos, José Luis; Martínez Roca, C.; Pértega Díaz, Sonia; Sironvalle Soliva, S.Objective: The aim of this comparative double-blind, prospective, randomized, clinical trial was to evaluate two amoxicillin administration patterns. The first was a short prophylactic therapy and the second a long postoperative regimen. Study Design: The study population consisted of 160 patients who underwent mandibular third molar extraction. Patients were randomized into two equal groups. In group 1, 2 grams of amoxicillin were administered 1 hour before the procedure and 1 gram 6 hours after surgery. In group 2, patients received 1 gram of amoxicillin 6 hours after surgery followed by 1 gram every 8 hour for 4 days. All patients received the same number of tablets thanks to the use of placebo pills. A total of 25 variables were evaluated, such as alveolitis, surgical infection, number of analgesic needed, subjective pain scale, post-surgical inflammation, consistency of the diet, axillary temperature and millimetres of mouth opening loss after the surgery. Results: No statistically significant post-operative differences were found within the recorded parameters between the groups. Conclusions: Postoperative 4-days amoxicillin therapy is not justified.
- Odontostomatological therapeutic possibilities in patients with sleep apnea(2010) Martínez González, José María; Martínez Rodríguez, Natalia; Arias Irimia, Óscar; Martín Ares, María; Barona Dorado, CristinaObjectives: To evaluate the different therapeutic possibilities for treating Sleep Apnea/ Hypoapnea Syndrome (SAHS), as well as the effectiveness of such treatments, and to evaluate the epidemiological and clinical aspects of this syndrome. Study design: We carried out a meta-analytical, observational and retrospective study by selecting a total of 13 articles, which provided a sample size of 642 diagnosed cases of SAHS. Results: SAHS was more prevalent among males (88.7%) and the average age of diagnosis was 49.75 years old. In the majority of cases, these patients were found to be overweight, with an average body mass index of 28.32 Kg/ m². The average apnea / hypoapnea index was 31.64 apneas / hypoapneas per hour, which is therefore considered to be a moderate type of SAHS. The therapeutic approach involved intraoral mandibular advancement devices in 77.96% of the cases, followed by 16% of the patients who were treated with continuous positive airway pressure devices during sleep (CPAP), and lastly, 7% underwent surgical treatment. Conclusions: SAHS is a complex clinical condition that requires a multidisciplinary team in order to diagnose and treat it. There are several therapeutic possibilities available to professionals, which have obtained highly satisfactory results
- Myofibroma of the oral cavity. A rare spindle cell neoplasm(2010) Brasileiro, Bernardo Ferreira; Martins Filho, Paulo R.; Piva, Marta R.; Silva, Luiz Carlos F.; Nonaka, Cassiano-Francisco-Weege; Miguel, Márcia Cristina da CostaMyofibroma is an uncommon spindle cell neoplasm rarely found in oral cavity. Typically, this lesion is seen in neonates and infants with few cases reported in adults patients. In the oral cavity, myofibroma occurs within the submucosal or intramuscular tissue and has a predilection by the tongue, buccal mucosa and lips. Microscopically, a typical biphasic pattern can be observed. Misdiagnosis included benign and malignant spindle cell lesions of nerve tissue or smooth muscle origin, such as neurofibroma, leiomyoma and sarcomas. Thus, immunohistochemical staining is a useful tool to identify the nature of neoplastic cells and to reach an accurate diagnosis. An immunohistochemical panel consisting of antibodies to vimentin, SMA, HHF-35, S-100p and desmin must be achieved. In most cases, positivity for vimentin, SMA and HHF-25 can be observed. Our report describes a solitary myofibroma of the tongue of a 23-year-old man with emphasis in clinical, histopathological and immunohistochemical features of this lesion.
- Odontogenic cysts : demographic profile in a Brazilian population over a 38-year period(2010) Souza, Lélia Batista de; Gordón Nuñez, Manuel Antonio; Nonaka, Cassiano-Francisco-Weege; Medeiros, Marcell Costa de; Torres, Tabita Fernandes; Emiliano, Gustavo Barbalho GuedesObjective: To determine the distribution of odontogenic cysts diagnosed histologically over a period of 38 years in a Brazilian population according to age, gender and site affected and to compare these data with previously reported studies from other countries. Study design: A total of 1019 cases of odontogenic cysts diagnosed between 1970 and 2007 were studied. Clinical features obtained from the patient records and microscope slides were reviewed according to the 1992 World Health Organization classification. Results: The mean age was 31.0 years, and there was a predominance of females. The most frequent odontogenic cysts were radicular cysts (61.4%), followed by dentigerous cysts (20.1%) and odontogenic keratocysts (6.4%). Radicular cysts were more frequent in females (62.0%), and the maxillary teeth were the site most commonly involved (63.05%). The peak incidence of dentigerous cysts occurred in the second decade of life, with the posterior region of the mandible being the site most affected (46.3%), followed by the anterior region of the maxilla (27.8%). Odontogenic keratocysts showed a peak incidence between the third and fourth decades of life and predominance among females. The posterior region of the mandible was the site most frequently affected (65.6%). Conclusion: The present results showed a similar frequency of odontogenic cysts in this Brazilian population and other populations around the world, with inflammatory cysts being identified as the most frequent odontogenic cyst. Radicular cysts, dentigerous cysts, and odontogenic keratocysts are the most common cystic lesions, accounting for 87.9% of all odontogenic cysts.
- Oral findings in Midline Syndrome : a case report and literature review(2010) Tallón Walton, Victòria; Nieminen, Pekka; Arte, Sirpa; Ustrell Torrent, Josep Mª; Carvalho Lobato, P.; Manzanares Céspedes, María CristinaWe describe a female patient with a midline syndrome. The patient presents agenesis of the corpus callosum, encephalocele, iris coloboma, hypertelorism, submucosal cleft palate and dental anomalies. Despite being very characteristic, her phenotypical traits do not coincide exactly with those reported to date in the literature. The karyotype and the molecular cytogenetic study do not show mutations. We identify the presence of dental anomalies in the mother and other family members, not being identified MSX1 and PAX9 mutations that could the related with their etiology. Despite the fact that dental agenesis has been related to a large number of other malformation syndromes and congenital conditions, dental anomalies have only rarely been mentioned when reporting midline syndromes. These dental phenotypical traits, present in the patient and her family, could be considered part of the midline syndrome in carriers as well as in the patients.
- Panoramic and tomographic implant studies : role in the diagnosis of sinus disorders(2010) Martínez González, José María; Barona Dorado, Cristina; Arias Irimia, Óscar; Martínez Rodríguez, Natalia; Fernández Domínguez, ManuelObjective: To study the presence of sinus disorders and their diagnosis based on clinical and radiographic findings, correlating their presence with tomography tests and panoramic radiography. Study design: We conducted a retrospective study on 152 patients who were seeking implant treatment, thereby allowing us to evaluate 42 patients who had abnormal sinuses. The patients underwent an evaluation of their medical history as well a clinical examination, panoramic radiography and tomographic study. Results: The average age of the patient was 59.8 years old, and 54.76% of the group were males and 45.23% were females. Prior respiratory disorders were present in 52.38% of the patients, and 57.3% of the group presented dental disorders. In assessing the type of wound, we observed that 73.21% were mucosal hyperplasia and 26.78% were mucous cysts. Of the 56 sinuses affected, only 28.57% were diagnosed using panoramic radiography. Conclusions: Panoramic radiography has limitations in the diagnosis of sinus disorders; computerized tomography (CT) remains the most effective diagnostic test.
- Is PRP useful in alveolar cleft reconstruction? Platelet-rich plasma in secondary alveoloplasty(2010) Luaces Rey, Ramón; Arenaz Búa, Jorge; López-Cedrún Cembranos, José Luis; Herrero Patiño, Susana; Sironvalle Soliva, S.; Iglesias Candal, Emma; Pombo Castro, MaríaObjective: Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone defect with an alveoloplasty. The aim of this surgical procedure is to facilitate dental eruption, re-establish maxillary arch, close any oro-nasal communication, give support to nasal ala, and in some cases allow dental rehabilitation with osteointegrated implants. Study design: Twenty cleft patients who underwent secondary alveoloplasty were included. In 10 of them autogenous bone graft were used and in other 10 autogenous bone and platelet-rich plasma (PRP) obtained from autogenous blood. Bone formation was compared by digital orthopantomography made on immediate post-operatory and 3 and 6 months after the surgery. Results: No significant differences were found between both therapeutic groups on bone regeneration. Conclusion: We do not find justified the use of PRP for alveoloplasty in cleft patients? treatment protocol.
- Ostectomy versus osteotomy with repositioning of the vestibular cortical in periapical surgery of mandibular molars : a preliminary study(2010) García Mira, Berta; Ortega Sánchez, Bárbara; Peñarrocha Diago, María; Peñarrocha Diago, MiguelIntroduction: Accessing the tooth roots in periapical surgery (PS) requires the elimination of periapical bone. Objective: To compare the postoperative morbidity and prognosis following PS on mandibular molars by ostectomy, or by osteotomy with repositioning of the vestibular cortical. Material and Methods: A retrospective clinical study of mandibular molars subjected to PS with ultrasound. Two groups were considered according to the surgical procedure used to access the roots: Group 1 (G1) with ostectomy and Group 2 (G2) with osteotomy and repositioning of the vestibular cortical. Only patients who had properly followed the post-operative instructions, adequately completed the post-operative questionnaires, and with a minimum of 12 months follow-up were included in the study. Post-operative morbidity was evaluated, and a clinical and radiographic follow-up was carried out using the criteria established by von Arx and Kurt in 1999. The SPSS program version 15 for Windows was used, considering values of p?0.05 as statistically significant. Results: Seventy-five patients, including 18 men and 57 women, with 87 mandibular molars and 107 periapical lesions were subjected to PS. The mean age of the patients was 38.5 years old (range 15 ? 74 years old). The patients were monitored for an average of 27.2 months (range 12 ? 120 months). Sixty-six patients (78 teeth) were treated in G1, and 9 patients (9 teeth) in G2. There was no relationship between the size of the ostectomy and pain, swelling or prognosis (p>0.05). Patients who underwent ostectomy presented more swelling than those subjected to osteotomy (p<0.05). There was no relationship between prognosis and the variables studied (p>0.05). Conclusions: There was no statistically significant relationship between the surgical procedure used and postoperative pain or prognosis. Patients who underwent an ostectomy presented more swelling than those who were treated with an osteotomy and repositioning of the vestibular cortical.
- Histological evaluation of the effect of low-level laser on distraction osteogenesis in rabbit mandibles(2010) Kreisner, Paulo Eduardo; Blaya, Diego Segatto; Gaião, Lêonilson; Maciel Santos, Marconi Eduardo Sousa; Etges, Adriana; Santana Filho, Manoel; Oliveira, Marilia Gerhardt deObjectives: This study evaluated the action of low level laser therapy (LLLT) on the percentage of newly formed bone in rabbit mandibles that underwent distraction osteogenesis (DO). Study design: Ten rabbits underwent bone lengthening according to the following protocol: Latency ? 3 days; Activation ? 7 days 0.7 mm/d; and Consolidation ? 10 days. The control group was composed of 4 rabbits. The experimental group, composed of 6 rabbits, received infrared GaAlAs LLLT (?=830 nm, P=40 mW) according to the following protocol: point dose of 10 J/cm2 applied directly on the bone site that underwent DO during bone consolidation at 48-hour intervals. Results: The percentage of newly formed bone was greater in the LLLT group (57.89%) than in the control group (46.75%) (p=0.006). Conclusion: The results suggest that LLLT had a positive effect on the percentage of newly formed bone. Betterquality bone sites may allow early removal of the osteogenic distractors, thus shortening total treatment time.
- Ludwig's angina and ketoacidosis as a first manifestation of diabetes mellitus(2010) Infante Cossío, Pedro; Fernández Hinojosa, Esteban; Mangas Cruz, Miguel Ángel; González Pérez, Luis MiguelLudwig?s angina is a serious and rapidly progressive infectious process that spreads through the floor of the mouth and neck. In this paper we present an infrequent case of a patient who suffered an odontogenic infection with poor response to the previous treatment, which evolved towards a Ludwig?s angina combined with ketoacidosis in the context of a diabetes mellitus not known before. According to the literature reviewed, this case report represents the first contribution of a Ludwig?s angina and ketoacidosis as an initial manifestation of a diabetes mellitus. The airway management, the antibiotic prescription and the surgical drainage allowed the healing of the patient without medical complications. Factors of co-morbidity like the diabetes mellitus together with focus tooth of infection may eventually turn into serious medical complications as the diabetic ketoacidosis and develop potentially lethal cervical infections.
- Multifocal epithelial hyperplasia, a rare oral infection in Asia : report of twelve cases in Iran(2010) Mosannen-Mozaffari, Pegah; Falaki, Farnaz; Amirchaghmaghi, Maryam; Pakfetrat, Atessa; Dalirsani, Zohreh; Saghafi Khadem, ShadiObjectives: Multifocal epithelial hyperplasia (MEH) is benign, asymptomatic oral disease with viral etiology. The frequency of this disease varies widely from one geographic region to another, and can vary, from 0.002 to 35% depending on the population studied. Study design: Here we report the clinicopathological features of twelve cases of MEH referred to Oral Medicine Department of Mashhad Dental School for the first time in Iran. Records of patients with the diagnosis of MEH in our department during 7 years were analyzed and data were extracted. Results: Most of the patients were younger than 20-year-old (66%), and females were predominantly affected (7:12). The mean age of onset was 12.72±10.14 years and the mean duration was 52.54 ± 78.51 months. Patients had multiple, well circumscribed, soft, non tender, flattened papules, with a color similar to the adjacent mucosa, in different areas of the oral cavity but the most affected site was buccal mucosa. Familial history of such lesions was negative in all patients. Only three cases showed spontaneous regression. Conclusion: In spite of rare nature of this disease in Asia, it seems that it is not the case in Khorasan Province, southeast Iran.
- Oral findings in Midline Syndrome : a case report and literature review(2010) Tallón Walton, Victòria; Nieminen, Pekka; Arte, Sirpa; Ustrell Torrent, Josep Mª; Carvalho Lobato, P.; Manzanares Céspedes, María CristinaWe describe a female patient with a midline syndrome. The patient presents agenesis of the corpus callosum, encephalocele, iris coloboma, hypertelorism, submucosal cleft palate and dental anomalies. Despite being very characteristic, her phenotypical traits do not coincide exactly with those reported to date in the literature. The karyotype and the molecular cytogenetic study do not show mutations. We identify the presence of dental anomalies in the mother and other family members, not being identified MSX1 and PAX9 mutations that could the related with their etiology. Despite the fact that dental agenesis has been related to a large number of other malformation syndromes and congenital conditions, dental anomalies have only rarely been mentioned when reporting midline syndromes. These dental phenotypical traits, present in the patient and her family, could be considered part of the midline syndrome in carriers as well as in the patients.
- Odontogenic cysts : demographic profile in a Brazilian population over a 38-year period(2010) Souza, Lélia Batista de; Gordón Nuñez, Manuel Antonio; Nonaka, Cassiano-Francisco-Weege; Medeiros, Marcell Costa de; Torres, Tabita Fernandes; Emiliano, Gustavo Barbalho GuedesObjective: To determine the distribution of odontogenic cysts diagnosed histologically over a period of 38 years in a Brazilian population according to age, gender and site affected and to compare these data with previously reported studies from other countries. Study design: A total of 1019 cases of odontogenic cysts diagnosed between 1970 and 2007 were studied. Clinical features obtained from the patient records and microscope slides were reviewed according to the 1992 World Health Organization classification. Results: The mean age was 31.0 years, and there was a predominance of females. The most frequent odontogenic cysts were radicular cysts (61.4%), followed by dentigerous cysts (20.1%) and odontogenic keratocysts (6.4%). Radicular cysts were more frequent in females (62.0%), and the maxillary teeth were the site most commonly involved (63.05%). The peak incidence of dentigerous cysts occurred in the second decade of life, with the posterior region of the mandible being the site most affected (46.3%), followed by the anterior region of the maxilla (27.8%). Odontogenic keratocysts showed a peak incidence between the third and fourth decades of life and predominance among females. The posterior region of the mandible was the site most frequently affected (65.6%). Conclusion: The present results showed a similar frequency of odontogenic cysts in this Brazilian population and other populations around the world, with inflammatory cysts being identified as the most frequent odontogenic cyst. Radicular cysts, dentigerous cysts, and odontogenic keratocysts are the most common cystic lesions, accounting for 87.9% of all odontogenic cysts.
- Wegener's granulomatosis : description of a case with oral manifestation(2010) Reboll Ferrer, Rosa María; Zapater Latorre, Enrique; Calabuig Crespo , Consuelo; Basterra Alegría, JorgeWegener?s granulomatosis is a multisystemic granulomatous vasculitis that predominantly affects the airways and the kidneys, but may affect any organ. Otorhinolaryngological manifestations may be oral ulcers, gingival swelling or septal perforations that can cause saddle nose deformities, rhinitis, sinusitis and hearing loss. The oral ulcers usually occur when the disease is advanced. Renal involvement is characterized by focal and segmental glomerulosclerosis, and determines the evolution. The diagnosis is made by clinical symptoms and signs, the presence of c-ANCA and a positive biopsy. The anatomic pathology is characterized by vasculitis, granulomatous inflammation with multinuclear giant cells and necrosis. The prognosis has improved as a result of treatment with immunosuppressants associated with corticosteroids. We report a case of a 53-year-old patient with Wegener?s granulomatosis with oral manifestation, which began as chronic mastitis.
- Panoramic and tomographic implant studies : role in the diagnosis of sinus disorders(2010) Martínez González, José María; Barona Dorado, Cristina; Arias Irimia, Óscar; Martínez Rodríguez, Natalia; Fernández Domínguez, ManuelObjective: To study the presence of sinus disorders and their diagnosis based on clinical and radiographic findings, correlating their presence with tomography tests and panoramic radiography. Study design: We conducted a retrospective study on 152 patients who were seeking implant treatment, thereby allowing us to evaluate 42 patients who had abnormal sinuses. The patients underwent an evaluation of their medical history as well a clinical examination, panoramic radiography and tomographic study. Results: The average age of the patient was 59.8 years old, and 54.76% of the group were males and 45.23% were females. Prior respiratory disorders were present in 52.38% of the patients, and 57.3% of the group presented dental disorders. In assessing the type of wound, we observed that 73.21% were mucosal hyperplasia and 26.78% were mucous cysts. Of the 56 sinuses affected, only 28.57% were diagnosed using panoramic radiography. Conclusions: Panoramic radiography has limitations in the diagnosis of sinus disorders; computerized tomography (CT) remains the most effective diagnostic test.
