Medicina Oral, Patología Oral y Cirugía Bucal (Internet)

Immunohistochemical profile of canalicular adenoma of the upper lip: a case report

Canalicular adenoma is an uncommon benign salivary gland neoplasm that has a marked predilection for occurrence in the upper lip. It is composed of columnar cells arranged in branching and interconnecting cords of single or double cell thick rows. This tumor has an excellent prognosis after conservative surgical treatment in all locations. In the present report we describe, using immunohistochemistry, the expression of cytokeratins (CK), S-100 protein and EMA in a canalicular adenoma that arose in the upper lip of a 55-year-old female. Cells of the canalicular adenoma showed an immunohistochemical profile that indicates an excretory duct origin: most of these cells positively expressed AE1/AE3 cytokeratins and S100 protein. A comparison of the immunohistochemical features of canalicular adenoma with other salivary gland neoplasms that share similar histological features is discussed.

Papular purpuric gloves and socks syndrome: Presentation of a clinical case

Papular-Purpuric Glove-and-Sock Syndrome is a rare, infectious disease, of viral etiology, characterized by the presence of pruritus, edema and symmetrical erythema, very well defined at the wrists and ankles with a gloves-and-socks distribution. Other areas can be affected, with a moderate erythema appearing in cheeks, elbows, knees, armpits, abdomen, groin, external genitalia, internal face of the thighs and the buttocks. Erosions, small ulcers, enanthema and blisters can be observed in the oral cavity and lips, and less frequently in other mucous membranes. Complications are rare, although they can be severe, 50% of the published cases are related with the Parvovirus B19. Due to its oral involvement stomatologists should be aware of this syndrome in order to carry out a correct diagnosis of the disease.

El Síndrome Papular Purpúrico en Guante y Calcetín es un síndrome raro, infeccioso, de etiología, viral que se caracteriza por la presencia de prurito, edema y eritema simétricos, muy bien delimitadas a nivel de las muñecas y de los tobillos con el aspecto en guante y calcetín. Pueden afectarse otras áreas apareciendo un eritema moderado en mejillas, codos, rodillas, axilas, abdomen, ingles, genitales externos, cara interna de muslos y glúteos. En la cavidad oral y labios y menos frecuentemente en otras membranas mucosas se pueden observar erosiones , pequeñas úlceras, enantema y vesículas. Las complicaciones son raras aunque pueden ser severas El 50% de los casos publicados están relacionados con el Parvovirus B19. La afectación oral en este síndrome hace que deba ser conocido por los estomatologos para realizar un correcto diagnostico de esta enfermedad.

Mandibular involvement of solitary plasmocytoma: A case report

Plasma cell neoplasms (multiple myeloma, solitary plasmocytoma of bone and extra medullar plasmocytoma) are characterized by a monoclonal neoplastic proliferation of plasma cells. Solitary plasmocytoma of bone (SPB) is a localized form of them. SPB is most frequently seen in vertebrae and secondarily in long bones. Its presence in jaws is extremely rare and when it is seen, angulus and ramus mandible are most common sites of occurrence. Prognosis of SPB is worse than extra medullar plasmacytoma (EMP) and approximately 50% of SPB will transform to multiple myelom. A 76-year old woman consulted to our clinic with a chief complaint of slowly developed swelling in her mandible. She had an operation from caput femur because of plasmocytoma two months before. Panoramic radiography revealed a radiolucent lesion in the mandibular anterior region, 60×35 mm in dimension. Aspiration biopsy was performed and histopathological examination was reported as plasmocytoma. She was referred to the oncology department for treatment but died before the treatment finished.

Use of nonsteroidal antiinflammatory drugs in dental practice: A review

Nonsteroidal antiinflammatory drugs (NSAIDs) are drugs commonly prescribed in dental practice for the management of pain and swelling. Of these substances, paracetamol and ibuprofen are the most widely used. Their mechanism of action is based on the inhibition of cyclooxygenase, and therefore of prostaglandin synthesis. All of these drugs present a similar mechanism of action, as a result of which their side effects are also similar. The most frequent range from mild (e.g., nausea or vomiting) to serious gastric problems (such as gastric bleeding or perforation). Other side effects include an increased risk of vascular accidents (particularly acute myocardial infarction), renal toxicity secondary to a decrease in perfusion, and the risk of abnormal bleeding tendency due to the antiplatelet effect of these drugs. Their use is contraindicated in the third trimester of pregnancy, due to the induction of premature ductus arteriosus closure. The present study reviews the information currently available on NSAIDs, with special emphasis on those aspects related to dental practice.

Los AINES son fármacos de uso común en odontología para el manejo del dolor y de la inflamación siendo paracetamol e ibuprofeno los más utilizados. Su mecanismo de acción está ligado a la inhibición de la ciclooxigenasa y, por tanto, de la síntesis de prostaglandinas. Todos poseen un mecanismo de acción similar por lo que los efectos secundarios también son comunes. Los más frecuentes corresponden a alteraciones gástricas leves (como náuseas o vómitos) o graves (como hemorragia o perforación gástrica). Otros efectos secundarios incluyen el riesgo aumentado de accidentes vasculares (en particular de infarto agudo de miocardio), toxicidad renal por disminución de la perfusión y riesgo de diátesis hemorrágica por el efecto antiagregante plaquetario de estos fármacos. Su uso esta contraindicado en el tercer trimestre del embarazo por inducir el cierre prematuro del conducto arterioso. La intención del presente trabajo es revisar la información actual disponible sobre AINES con especial atención en aquellos aspectos relacionados con la odontoestomatología.

Update on gingival overgrowth by cyclosporine A in renal transplants

Severe gingival overgrowth is one of the most frequent side effects in renal transplant patients associated with assumption of cyclosporine A. Several associations with age, sex, dosage, duration of therapy or interval since transplantation have been hypothesized. The introduction of alternative immunosuppressant drugs have been suggested to permit better long-term transplant outcomes and a decrease in incidence of gingival overgrowth. The aim of the present paper is to summarize current knowledge regarding aetiology, pathogenesis and management of gingival overgrowth induced by Cyclosporine A.

El sobrecrecimiento gingival severo es uno de los efectos adversos más frecuentes en los pacientes con transplante renal asociado al suministro de ciclosporina A. Se han realizado hipótesis sobre diversas asociaciones con la edad, sexo, dosis, duración de la terapia o intervalo desde el transplante. Se ha propuesto la introducción de la alternativa de drogas inmunosupresoras para permitir mejores resultados a largo plazo del transplante y la disminución en la incidencia de sobrecrecimiento gingival. El objetivo del presente estudio es resumir el conocimiento actual, observando la etiología, patogénesis y dirección del sobrecrecimiento gingival inducido por la ciclosporina A.

Synovial chondromatosis of the temporomandibular joint

Synovial Chondromatosis (SC) is a disease whose etiology is unknown, can be defined as a benign synovial process characterized by the formation of metaplastic cartilaginous nodes inside connective tissue of articular surfaces, is considered an active metaplastic phenomenon better than a neoplastic process; it presents a greater preference to affect women who constitute almost 70% of reported cases, the age range is wide and oscillates between 18 - 75 years (average 44.6 years). Between the main clinical findings are: pain, crackle, volume augmentation and a limited buccal opening. SC is an unusual state and the reports in the English literature are no more than 75 cases, only 66 of those where histologically verified, most of those were affecting great joints like hip, knee and shoulder, but if SC is not frequent in this sites, is even more infrequent on temporomandibular joint. The aim of this paper is to report a clinical case and at the same time to realize a brief review of the literature.

La condromatosis sinovial (CS) es una enfermedad de etiología desconocida, la cual pude definirse como un proceso benigno sinovial caracterizado por la formación de nódulos cartilaginosos metaplásicos dentro del tejido conectivo de las superficies articulares, se le considera un fenómeno metaplásico activo más que un proceso neoplásico; presenta una marcada preferencia por afectar a mujeres constituyendo casi el 70% de los casos reportados, el rango de edad es amplio y oscila entre los 18 y 75 años con una media de 44.6 años. Dentro de los principales hallazgos clínicos destacan: sintomatología dolorosa, presencia de crepitación, aumento de volumen y limitación de la apertura bucal. La CS es una entidad poco frecuente de la cual se han reportado no más de 75 casos en la literatura inglesa, sólo 66 de ellos comprobados histológicamente, la mayoría afectando principalmente grandes articulaciones como cadera, rodilla y hombro; pero si la frecuencia es rara en estas localizaciones, lo es más aún en la articulación temporomandibular. El objetivo del presente artículo es el de reportar un caso clínico a la vez que se realiza una breve revisión de la literatura.

Polymorphous low-grade adenocarcinoma of the parotid gland: Case report and review of the literature

Polymorphous low-grade adenocarcinoma (PLGA) is difficult to diagnose both clinically and histologically due to its indolent presentation, and because of its morphological diversity that includes several microscopic patterns. The aggressive biologic behavior seen in minor salivary glands as compared to major glands is apparently associated histologically to a predominance of the papillary pattern in the former. Biologic behavior of PLGA in the major salivary glands is uncertain, as some cases have developed recurrences and metastases independently of the presence of a papillary pattern. A case of PLGA originated de novo in parotid gland is presented a 60 year-old male, treatment was surgically excised through superficial parotidectomy and to postoperative radiotherapy (46 Gy). Forty-eight months later the patient is alive with no signs of recurrence, as well as a review of the literature, with particular emphasis in its differential diagnosis and biological behavior.

A large ameloblastic fibro-odontoma of the right mandible

The ameloblastic fibro-odontoma is a rare mixed odontogenic tumor. It occurs predominantly in children and young adults with no sex predilection and locates most often in the posterior segment of the mandible. A painless swelling is the most common clinical sign. Radiologically, ameloblastic fibro-odontoma shows a circumscribed radiolucency, which contains radio-opaque foci of various sizes and shapes. Histological examination reveals a fibrous soft tissue, islands of odontogenic epithelium and a disordered mixture of dental tissues. The tumor produces enamel or enamel matrix, dentin and cementum. The treatment of ameloblastic fibro-odontomas usually consists of enucleation or surgical curettage, which is possible due to their benign biological behaviour.

Effects of diabetes on the osseointegration of dental implants

The increased prevalence of diabetes mellitus has become a public health problem. Hyperglycaemia entails a rise in the morbidity and mortality of these patients. Although a direct relationship with periodontal disease has already been shown, little is known about the results of dental implants in diabetics. The present paper reviews the bibliography linking the effect of diabetes on the osseointegration of implants and the healing of soft tissue. In experimental models of diabetes, a reduced level of bone-implant contact has been shown, and this can be reversed by means of treatment with insulin. Compared with the general population, a higher failure rate is seen in diabetic patients. Most of these occur during the first year of functional loading, seemingly pointing to the microvascular complications of this condition as a possible causal factor. These complications also compromise the healing of soft tissues. It is necessary to take certain special considerations into account for the placement of implants in diabetic patient. A good control of plasma glycaemia, together with other measures, has been shown to improve the percentages of implant survival in these patients.

El incremento en la prevalencia de la diabetes mellitus se ha convertido en un problema de salud pública. La hiperglucemia conlleva un aumento en la morbilidad y mortalidad de estos pacientes. Aunque ya se ha demostrado una relación directa con la enfermedad periodontal, poco se conoce sobre el resultado del implante dental en el sujeto diabético. En el presente trabajo se revisa la bibliografía que relaciona el efecto de la diabetes sobre la oseointegración de los implantes y la cicatrización de los tejidos blandos. En modelos experimentales de diabetes se ha demostrado una reducción en los niveles de contacto hueso-implante, que puede ser revertida mediante tratamiento con insulina. En el paciente diabético, comparado con la población general, se observa un mayor índice de fracaso. La mayoría de ellos se producen durante el primer año de carga funcional, lo que parece señalar a las complicaciones microvasculares de la enfermedad como posible factor causal. Dichas complicaciones comprometen también la cicatrización de los tejidos blandos. Se hace necesario establecer unas consideraciones especiales para la colocación de implantes en el paciente diabético. El buen control de la glucemia plasmática, junto con otras medidas, ha demostrado mejorar los porcentajes de supervivencia de los implantes en estos pacientes.

Antimicrobial prophylaxis in oral surgery and dental procedures

Transient bacteraemia is a known risk factor following oral surgery and invasive dental procedures in patients with altered immune system response and those with a susceptible site of infection (patients with heart valve prostheses or recent joint replacements, etc.) The most commonly isolated aerobic bacteria in postoperative bacteraemia are Streptococcus Viridans. However, other periodontal pathogenic anaerobic bacteria are found in up to 64% in blood cultures (mixed bacteria or anaerobic bacteria alone). Dental pathogenic bacteria do not appear to be covered by standard amoxicillin or clindamycin prophylactic regimens. This is partly due to the fact that these anaerobic bacteria often produce beta lactamase and also in view of results of antimicrobial sensitivity tests observed in recent studies. A personal history of exposure to dental pathogenic bacteria may have an impact on the patients global health, not only because of classical local or systemic infectious complications, but also because dental pathogenic bacteria have been found in atheromatous plaques in coronary and carotid arteries. This finding, along with epidemiological data, suggests that such bacteria may contribute to the progression of vascular arteriosclerotic lesions and the occurrence of cardiovascular and/or cerebrovascular accidents, although the pathogenic mechanisms involved are not yet well known. Taking these facts into consideration, and in view of antimicrobial sensitivity data available at present, we believe that the use of amoxicillin/clavulanic acid is the most appropriate option for prophylaxis of all infectious risks associated with bacteraemia of oral origin, due to its broader cover of dental pathogenic bacteria and its pharmacokinetic profile.

Tras la cirugía oral y los procedimientos odontológicos invasivos, la bacteriemia transitoria es un factor de riesgo conocido para los pacientes que sufren alteraciones del sistema inmune y para aquellos que presentan focalidad susceptible (pacientes con prótesis valvulares cardiacas o prótesis articulares recientes, entre otros). Los Streptococcus viridans son las bacterias aerobias aisladas con mayor frecuencia en las bacteriemias postquirúrgicas orales; no obstante otras bacterias odontopatógenas anaerobias se encuentran por hemocultivo hasta en el 64% de los casos (tratándose en estos casos de bacteriemias mixtas o exclusivamente anaerobias). Las bacterias odontopatógenas no parecen bien cubiertas con el régimen profiláctico estándar de amoxicilina o clindamicina, debido, entre otras causas, a la frecuente producción de betalactamasas por dichas bacterias anaerobias y a los resultados de las pruebas de sensibilidad antimicrobiana observados en estudios recientes. La historia personal de exposición a bacterias odontopatógenas puede repercutir en la salud global del individuo, no sólo por las complicaciones infecciosas clásicas: locales o sistémicas, sino por el hecho de haber sido encontradas bacterias odontopatógenas en placas de ateroma de arterias coronarias y carótidas; sugiriendose con este hallazgo, y por los datos epidemiológicos, que puedan contribuir (por mecanismos patogénicos aún no bien conocidos) a la progresión de lesiones vasculares arterioescleróticas y a la aparición de accidentes cardiovasculares y/o cerebrovasculares. Tomando en consideración estos hechos y los datos de sensibilidad antimicrobiana disponibles, el empleo de amoxicilina/clavulánico nos parece la opción más adecuada como profilaxis de todos los riesgos infecciosos asociados con la bacteriemia de origen oral, por su mayor cobertura frente a las bacterias odontopatógenas y su mejor perfil farmacocinético.

Oral leiomyoma in retromolar trigone: A case report

Leiomyomas are bening tumours originated on smooth muscle. The most frequent site of appearance are uterine myometrium, gastrointestinal tract and skin. The highest incidence ocurs between 40 and 49 years of age. Its presentation is unusual in children or in older patients. Leiomyomas are unfrequent in the oral cavity, but in this location are usually localized on tongue, lips and palate. Leiomyomas use to appear as well-defined masses, with slow growth and totally asymptomatic. Pain is present just in rare cases. The treatment is surgical escision. Recurrences are extremely unfrequent. The diagnosis is mainly determined by histological studies due to its unspecific clinical appearance. Histopathologicaly proliferation of smooth muscle cells is observad without necrotic areas. A low number of mitotic figures can be seen. We present the case report of a 25-year old male patient, with a leiomioma on his right retromolar trigone.The low incidence of this pathology, the age of the patient and the inusual location, make the report of the case worthy.

Los leiomiomas son tumores benignos originados en el músculo liso. Su localización más frecuente es el útero, el tracto gastro-intestinal y la piel. Se presenta habitualmente entre los 40 y 49 años de edad, siendo muy rara su aparición en la infancia y en la senectud. Son muy infrecuentes a nivel de la cavidad oral, pero cuando se dan en esa localización, asientan principalmente en la lengua, los labios o el paladar. Inicialmente suelen presentarse como una masa muy bien definida, de lento crecimiento y totalmente asintomática. En raras ocasiones producen dolor. Su tratamiento es casi siempre quirúrgico, siendo las recurrencias excepcionales. Dada su clínica inespecífica, su diagnóstico es principalmente histológico, observándose en las muestras una proliferación de células musculares lisas, sin focos de necrosis y con escasas mitosis. Presentamos el caso clínico de un paciente de 25 años de edad con un leiomioma en trígono retromolar derecho. Dada la escasa incidencia de este tipo de patología, la edad del paciente y su inusual ubicación, se justifica la presentación de este caso.

Primary leiomyosarcoma of the mandible: A case report

The aim of this article is to describe a case of leiomyosarcoma of the mandible with immunohistochemical analysis that was useful in making the final diagnosis. A 40-year-old woman was referred to the Stomatology Clinic of São Paulo Tatuapé Hospital, , for evaluation of a lesion on the left side of the mandible. This lesion presented a fast growth in the last 6 months. Intraoral examination showed a firm, fixed, red colored mass measuring, approximately 60-mm in diameter. No lymph nodes involvement was found. The radiographic examination showed a lytic lesion showed ill-demarcated radiolucent with facial and lingual cortical bone destruction. Microscopic examination of the mandibular lesion showed a neoplasm composed by interlacing fascicles of spindle-shaped cells. Most of the cells presented a blut-ended elongated shape. A marked cellular pleomorphism was observed, represented by cells with irregular shape and abundant eosinophilic cytoplasm. Nuclei were large, hyperchromatic, either vacuoled or cigar-shape. The cytoplasm of the cells stained red with Massons trichrome stain. Neoplastic cells expressed vimentin, smooth-muscle actin, HHF-35 and desmin. These findings were consistent with the diagnosis of leiomyosarcoma.

Evaluation of lidocaine and mepivacaine for inferior third molar surgery

Objective: The aim of this study was to compare 2% lidocaine and 2% mepivacaine with 1:100,000 epinephrine for postoperative pain control. Study design: A group of 35 patients, both genders were recruited, whose had ages ranged from 13 to 27 years-old and had two inferior third molars in similar positions to be extracted. The cartridges were distributed to the patients according to a randomised pattern, where lidocaine was in the control group and mepivacaine in the experimental group. Results: Results showed no significant association between the anesthetics and postoperative pain, pulp sensibility after one hour, gender, tooth position and duration of the surgical procedure. Conclusions: It was shown that lidocaine and mepivacaine have similar time of anesthesia, they are adequate for surgical procedures that last one hour, and there was no difference between the two anesthetics in relation to the severety of post-operative pain.

Clinical and radiological course in apicoectomies with the Erbium: YAG LASER

Objective. A study is made of the efficacy of the Erbium:YAG laser in granulomatous periapical lesions, based on clinical and radiographic controls. Material and methods. The study comprised a series of 45 patients amenable to periapical surgical treatment of incisors, canines and premolars. A conventional surgical technique was used, with silver amalgam retrograde filling and irradiation of the bone defect and remnant root cement with the Erbium:YAG laser. Clinical and radiographic controls were made during 24 months, assessing the absence of symptoms and the presence of pain, swelling or fistula and ossification of the lesions, respectively. Results. The clinical course proved asymptomatic in 95.5% of the cases. As regards remodeling of the bone cavity, 77.7% had completed ossification after 24 months, 13.3% were in an advanced stage of ossification and 4.5% in an intermediate stage, while 4.5% showed treatment failure. Conclusions. The combination of silver amalgam and irradiation with the Erbium:YAG laser in periapical surgery showed a very high clinical success rate, with a 77.7% bone cavity remodeling rate after 24 months.

Objetivo. Valorar la eficacia del láser de Erbium:YAG en lesiones granulomatosas periapicales, mediante controles clínicos y radiográficos. Material y método. Estudio clínico en el que participó una muestra de 45 pacientes susceptibles de tratamiento quirúrgico periapical en dientes incisivos, caninos y premolares. Realizándose una técnica quirúrgica convencional con relleno retrógrado de amalgama de plata e irradiación del defecto óseo y cemento radicular remanente con láser de Erbium:YAG. Se realizaron controles clínicos y radiográficos durante 24 meses, valorando la ausencia de síntomas o la presencia de dolor, inflamación o fístula y osificación de las lesiones respectivamente. Resultados. La evolución clínica de los pacientes en un 95,5% de los casos fue asintomática. En cuanto a la remodelación de la cavidad ósea el 77,7% terminaron su osificación a los 24 meses, el 13,3% se encontraban en un estadio avanzado, el 4,5% en un estadio intermedio y en otro 4,5% fracasó el tratamiento. Conclusiones. La combinación de amalgama de plata e irradiación con láser de Erbium:YAG en cirugía periapical supuso un éxito clínico muy elevado y una remodelación de la cavidad ósea del 77,7% a los 24 meses.

Iatrogenic mandibular fracture associated with third molar removal: Can it be prevented?

Removal of third molars is the most common procedure in oral surgery. It may be associated with complications, such as sensory damage , dry socket, infection and iatrogenic damage. A case of mandibular angle fracture during third molar extraction in a 37-year-old female is reported. Literature review on the possible etiologies and ways of prevention were recorded. The reason is believed to be multifactorial and include: age, gender, degree of impaction, relative volume of the tooth in the jaw, preexisting infection or bone lesions, failure to maintain a soft diet in the early postoperative period and the surgical technique. It is possible to reduce the risk of this complication by adoption of preventive measures.

Mandibular ameloblastoma: Reconstruction with iliac crest graft and implants

The ameloblastoma is a bening odontogenic tumor. The treatment planning in young persons is still not clear. We describe a case report of a young boy who was treated in our unit and we review the different aproaches for this type of lesions, which nowadays still not clear in this patients.

El ameloblastoma es un tumor odontogénico benigno.El plan de tratamiento en pacientes jovenes sigue siendo controvertido. Describimos un caso clinico de un varón joven tratado en nuestro servicio y revisamos los diferentes enfoques de este tipo de lesiones, que a dia de hoy sigue sin estar claramente definido.

Subcutaneous emphysema secondary to dental treatment: Case Report

Subcutaneous emphysema is a relatively rare complication of dental treatment, although increasingly due to the use of high pressure air instruments. Many cases go unrecognized or are misdiagnosed. Majority of patients with this complication resolve spontaneously after 5 to 10 days, however some can advance to potentially life-threatening complications. A case of subcutaneous emphysema during restorative procedure in a 52-year-old woman was treated in the Docent Odontological Clinic of the Frontera University is presented. The differential diagnosis and management of this condition is discussed. Our purpose is not to add one more case of emphysema to literature, but to show dentists that in simple restorative procedures using air pressure instruments, they could be exposed to this complication.

El enfisema subcutáneo es una complicación poco frecuente en la práctica odontológica, que ha ido en aumento debido al uso de instrumentos con aire a presión. Muchos de los casos no son reconocidos o presentan un diagnóstico errado. La mayor parte de los pacientes con esta complicación presentan resolución espontánea después de 5 a 10 días, sin embargo, algunos pueden evolucionar con complicaciones que ponen en peligro la vida. Se presenta un caso de enfisema subcutáneo desencadenado durante un procedimiento restaurador en una mujer de 52 años que fue atendida en la Clínica Odontológica Docente Asistencial de la Universidad de la Frontera. Se discuten el diagnóstico diferencial y el manejo de esta condición. El objetivo de esta presentación no es agregar un caso clínico más de enfisema a la literatura, sino que mostrar a los dentistas que en procedimientos restaurativos simples usando instrumentos con aire a presión pueden verse expuestos a esta complicación.

Control of Freys syndrome in patients treated with botulinum toxin type A

Aim: To identify the severity of Freys syndrome and its response to botulinum toxin type A. Methods: Minor test was performed in all cases to assess the extent of the affected area, using the contralateral side as control. Severity was assessed according to the proposal of Luna-Ortiz et al. Response was evaluated after 3 and 6 months, and was compared with the basal data. Results: Freys syndrome was documented in 38 patients, but only 23 cases accepted the botulinum toxin type A treatment. Severity was moderate in 8 (35%) and severe in 15 (65%) cases. Mean applied dose was 1.41 MU/cm² in 21 patients (91%), whereas one patient was treated with 10 MU for a 0.8 cm² affected area (12.5 MU/cm²) and another patient with 10 MU for a 0.5 cm² affected area (20 MU/cm²) due to severity of their symptomatology. Average affected area at the beginning was 14.2 cm², while after 3 and 6 months of treatment it was 4.1 cm² and 4.4 cm² respectively (p<0.001). The two patients that received higher doses of botulinum toxin A had complete response. Complete response was observed in 13 patients (56.5%) at 3 months, but in only nine (39%) this lack of symptomatology persisted at 6 months. In three cases (13%) no response was obtained at 3 months, and the application of an additional dose of botulinum toxin type A produced no response in two of them after 6 months. Comparison of the severity score of the average basal value vs. that obtained at 3 and 6 months revealed a significant difference (p< 0.05); however, no statistically significant difference was found when comparing outcome at 3 vs. 6 months. There were no statistically significant differences using the independent samples test when comparing outcome after treatment in relation to gender, type of surgery, or use of postoperative radiation therapy (p>0.05). In conclusion, botulinum toxin A remains as the treatment of choice for Freys syndrome.