Scielo RSS <![CDATA[Medicina Oral, Patología Oral y Cirugía Bucal (Internet)]]> vol. 12 num. 8 lang. en <![CDATA[SciELO Logo]]> <![CDATA[Polymorphous low grade adenocarcinoma: Review and case report]]> Polymorphous Low-Grade Adenocarcinoma is a rare, malignant salivary gland tumor, which is found almost exclusively in minor salivary glands. It is more frequent in the age range from 30 to 70, with a clear female predilection in a 2:1 ratio. It is usually located in the hard or soft palate, although it may be found in the rest of the oral cavity too. It is rare in major salivary glands. In general it has good prognosis, with recurrence rates in the range of 17% - 24%. Although rare, metastasis to regional lymph nodes may occur in 9% of the cases. This report describes the case of a patient that consulted at the Military Odontological Center (Central Odontológica del Ejército) due to an esthetic alteration of her dental prosthesis, which had been made 8 years before. The patient was sent to the Maxillofacial Surgery Service, where the intraoral examination showed a big mass compromising the hard palate and the alveolar ridge. During examination, a dent in her prosthesis was found to correspond to the tumor mass; it was therefore concluded that the tumor had at least an eight-year-old evolution. An incisional biopsy was carried out, and once the polymorphous low-grade adenocarcinoma diagnosis had been stated, the patient was sent to the Head and Neck Surgery Service of the Military Hospital, where the lesion was treated by wide surgical excision followed by radiation therapy. <![CDATA[Plasmacytoid myoepithelioma of the palate: Report of one case and review of the literature]]> Introduction: Myoepithelioma is a benign neoplasm of salivary glands, represents 1.5 % of all salivary glands neoplasm. The plasmacytoid myoepithelioma from palate salivary glands is considered as a rare entity, at date it has been reported 14 cases. It is present one case of plasmacytoid myoepithelioma of palate. Case report: A Hispanic female of 28 years old presented a not-ulcerate, painless ovoid swelling at left side of hard palate with a one year and a half of evolution. An excisional biopsy was done. The sample was fixed at 10% buffer formalin, embedded in paraffin, cuts at 5 µ and stained with H-E. Microscopically, the lesion was composed by myoepithelial neoplastic cells characterized by a round ovoid silhouette, an eccentric nuclei of dense chromatin and eosinophilic cytoplasm. In some myoepithelial neoplastic cells were identifies intranuclear cytoplasmatic inclusions. The lesion was analysed with immunohistochemical technique using the follow antibodies: vimentin, citokeratin AE1/AE3, S100 protein and actin muscle specific. We observe positive immunoreactivity against vimentin, citokeratin, S100 protein and actin muscle specific. A diagnosis of plasmacytoid myoephitelioma of palate salivary glands was done. Our findings supports the suggestion about plasmacytoid myoepithelioma is an independent entity. The histological diagnostic parameters of plasmacytoid myoepithelioma versus pleomorphic adenoma are discussed. <![CDATA[Extramedullary hematopoiesis within endothelial papillary hyperplasia (Masson’s pseudoangiosarcoma) of the tongue]]> We report the unique association of Masson’s pseudoangiosarcoma (endothelial papillary hyperplasia) and extramedullary hematopoiesis. The lesion was present as a violaceous nodule on the side of the tongue of a 78-year-old man with history of multiple myeloma and long-standing mild anemia. This association between a peculiar form of thrombus organization and extramedullary hematopoiesis has been reported previously only once, in an infant with a cranial hematoma, and raises interesting pathogenetic questions. <![CDATA[Oral necrotizing microvasculitis in a patient affected by Kawasaki disease]]> Kawasaki disease (KD) was first described in 1967 by Kawasaki, who defined it as "mucocutaneous lymph node syndrome". KD is an acute systemic vasculitis, which mainly involves medium calibre arteries; its origin is unknown, and it is observed in children under the age of 5, especially in their third year. The principal presentations of KD include fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Within KD, oral mucositis - represented by diffuse mucous membrane erythema, lip and tongue reddening and lingual papillae hypertrophy with subsequent development of strawberry tongue - can occur both in the acute stage of the disease (0-9 days), and in the convalescence stage (>25 days) as a consequence of the pharmacological treatment. KD vascular lesions are defined as systemic vasculitis instead of systemic arteritis. This study analyzed the anatomical-pathological substrata of oral mucositis in a baby affected by Kawasaki disease and suddenly deceased for cardiac tamponade caused by coronary aneurysm rupture (sudden cardiac death of a mechanical type). <![CDATA[Diagnostic evaluation of serial sections of labial salivary gland biopsies in Sjögren’s syndrome]]> Objectives: Sjögren’s syndrome is a chronic inflammatory disease. The detection of chronic inflammatory infiltrates containing >50 lymphocytes (lymphocytic focus) per 4 mm2 tissue in minor salivary gland biopsies is a diagnostic parameter of the disease. The aim of the study was to examine if an increase in the tissue area of a single minor labial salivary gland biopsy through serial histological sections in patients affected by primary Sjögren’s syndrome could facilitate the detection of the diagnostic focus score (grades >1 or >2). Methods: We observed 24 labial salivary gland biopsies from patients affected by primary Sjögren’s syndrome, diagnosed according to the clinical-laboratory criteria proposed by the American-European Consensus Group. The analysis was carried out on sections (n= 72) obtained at three different levels at 200 micrometers from one another. The serial sections regarding the 3 levels were reviewed by the same oral pathologist, who detected both the total number of foci, and their surface, calculating a cumulative focus score. Results: No significant correlation was found between the number of lobules per histological section and the focus score (Pearson correlation 0.363, p= 0.01). No significant variation in focus score distribution was identified in the three serial histological levels at 200 micrometers from one another. From the comparison between the number of lobules observed and the focus score grade, no direct proportionality between the amount of parenchyma analyzed and the focus score was found. Conclusions: The focus score remained unchanged in the serial sections at different depths. <![CDATA[Program for coordinated dental care under general anaesthesia for children with special needs]]> Aim: To draw up a program for coordination of dental care for children with special needs between the Course at the Universidad Complutense de Madrid (UCMC) (Specialisation in holistic dental care for children with special needs), and the Disabled Children’s Oral Health Unit (DCOHU) within the Madrid Health Service (SERMAS). Material and methods: UCMC Protocol for children with special needs. Design of a clinical pathway based on consensus amongst the professionals involved. Results: Algorithm for dental care for children with special needs. Matrix covering all activities and timing for full dental diagnosis in such patients (general health, oral health and behaviour) to facilitate proper referral of patients requiring general anaesthesia. Inclusion in the matrix of those responsible for each activity. Conclusions: Improved team work (University - primary health care) in patient evaluation, in provision of information to parents and guardians and in health care quality. From the teaching point of view, students learn to adopt a systematic approach in the decision-making process. <![CDATA[How to improve communication with deaf children in the dental clinic]]> It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towards the deaf is not always correct. A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups - lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading, hearing-aids plus lip-reading). Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), the existence of associated problems (learning difficulties), degree of loss of hearing, age, etc. <![CDATA[New dental simulator for microsurgical training preliminary overview]]> Objective: To present a new simulator designed at the Minimally Invasive Surgery Centre (Cáceres) which offers an integral, effective and viable training system that can be used for learning microsurgical techniques. Study design: A square methacrylate block was used. Animal jaws were fixed to the sides by means of butterfly screws. This block also has a drainage tube to facilitate the escape of fluids. Results: Excellent results were obtained using this simulator in microsurgical suturing training in dental, Oral and Maxillofacial Surgery Conclusions: We believe that this simulator is an essential component in microsurgical training. It is an ethically and morally valid training method with which various suturing techniques can be practised before using live animals and before applying these to daily clinical practice. <![CDATA[The post-endodontic periapical lesion: Histologic and etiopathogenic aspects]]> Apical periodontitis is produced in the majority of cases by intraradicular infection. Treatment consists in the elimination of the infectious agents by endodontia. Even when carrying out a correct cleansing and filling of canals, it is possible that periapical periodontitis will persist in the form of an asymptomatic radiolucency, giving rise to the post-endodontic periapical lesion. The chronic inflammatory periapical lesion is the most common pathology found in relation to alveolar bone of the jaw. From the histological point of view, it can be classified as chronic periapical periodontitis (periapical granuloma), radicular cyst, and as scar tissue. The most frequent is the periapical granuloma, constituted by a mass of chronic inflammatory tissue, in which isolated nests of epithelium can be found. The radicular cyst is characterized by the presence of a cavity, partially or wholly lined by epithelium. Scar tissue is a reparative response by the body, producing fibrous connective tissue. The aim of this study is to review and update the etiopathogenic and histological aspects of chronic post-endodontic periapical lesions. <![CDATA[Drill failure during ORIF of the mandible: Complication management]]> A case of a drill breakage during open reduction and internal fixation (ORIF) of a mandibular fracture is reported. The clinical decision, diagnosis and surgical management of the complication are described. <![CDATA[Botryoid odontogenic cyst: clinical and pathological analysis in relation to recurrence]]> Objetives. Botryoid odontogenic cyst (BOC) is considered as an unusual multilocular variant of lateral periodontal cyst (LPC). Review of the literature indicates that this lesion has higher risk of recurrence than LPC, but objetive reasons are still unknown. The aim of this study is identify main clinical and pathological variables associated with the risk of recurrence. Study design. A complete literature review about cases of BOC was made, from its first description up to the year 2006. A total of 67 cases of BOC were identified from year 1973 (first case) to the last publication in 2005. Results. 85.2% of the BOCs were located in the jaw, affecting to women (54.8% of the cases) in the fifth decade of the life. This lesion shows a well- circumscribed unilocular (60%) or multilocular (40%) radiolucency. Recurrence rate of cases with follw-up data was 32,4%. Conclusions. Size and multilocular patterns could be the main factors associated to recurrence in BOC. <![CDATA[Spontaneous fracture of the mandibular genial tubercles: A case report]]> Fracture of the mandibular genial tubercles is an uncommon pathology affecting edentulous patients with severe maxillary atrophy. Usually occurs spontaneously which complicates the diagnosis. Their importance lies in the functional alterations, which occur as a consequence of the disinsertion of the genihyoid and genioglossus muscles. The treatment of fracture of the genial tubercles is controversial, including no surgical intervention, excision of the avulsed bone fragments, and muscular repositioning. There have been only 11 cases reported in the literature of this fracture, most of them spontaneous. We present a difficult diagnosis situation of spontaneous fracture of the genial tubercles in an 86-year-old edentulous female with a painful sublingual and submental hematoma and anterior cervical echimosis. Computerized Tomography should be made to confirm the diagnosis. Surgical treatment was not necessary, and follow-up at 6 months revealed complete symptomatic recovery, and full return of function. <![CDATA[Progressive facial hemiatrophy with associated osseous lesions]]> Progressive facial hemiatrophy (PFH) is a rare condition characterized by the slow, progressive appearance of a unilateral facial atrophy that affects the skin, subcutaneous tissue, muscle and bone. We report the case of a 60-year-old female patient whose cutaneous symptoms commenced in 1987 in the form of a purplish erythema on the left side of her face and neck, which subsequently remitted giving rise to an indurated region in the left maxillary region. Since 1995 until the present day, she has developed facial hemiatrophy on the left side accompanied by progressive osseous reabsorption of the upper maxilla and left mandible with atrophy of soft tissue. The association of the onset of PFH with progressive osteolysis of the maxilla has not been previously reported in an adult patient. <![CDATA[Third canal in the mesial root of permanent mandibular first molars: Review of the literature and presentation of 3 clinical reports and 2 in vitro studies]]> Introduction. Systematic anatomical studies corroborate the anatomical complexity of the root canal system. Deviations from the norm such as multiple orifices, apical deltas, accessory canals and other variations are frequent. Objectives. To present clinical reports of mandibular molars with three canals in the mesial root and two in vitro studies of the morphology of these canals, together with a review of the literature. Materials and Methods. Three clinical reports are presented of mandibular molars where three canals in the mesial roots were treated endodontically. Two in vitro studies were performed, one using computerized tomography and the other with scanning electron microscopy, to describe the morphology of the mesial root canals of permanent first molars. The scientific literature on this anatomical situation was also reviewed. Results. The tomographic study found that the prevalence of a third mesial canal in the 27 teeth analysed was 14.81%; the microscopic study of 25 teeth found it to be 12%. The review of the literature encountered that the authors who report cases such as these found prevalences ranging from 1% to 15%. Conclusions. From the teeth analysed in vitro, it is concluded that a third mesial canal may be present in a mandibular first molar in approximately 13% of cases. Clinically, the third canal is difficult to find and exhibits a very variable morphology, which may present anastomosis with the other canals. <![CDATA[Biomechanical aspects of external root resorption in orthodontic therapy]]> External apical root resorption is a common phenomenon associated with orthodontic treatment. The factors relevant to root resorption can be divided into biological and mechanical factors. Some mechanical and biological factors might be associated with an increased or decreased risk of root resorption during orthodontic treatment. For mechanical factors, the extensive tooth movement, root torque and intrusive forces, movement type, orthodontic force magnitude, duration and type of force are involved. For biological factors, a genetic susceptibility, systemic disease, gender and medication intake have been demonstrated influence root resorption. Orthodontic therapy of patients with increased risk of root resorption should be carefully planned. Medical history, medication intake, family history, tooth agenesis, root morphology, oral health and habits must be considerate if we do not want jeopardize our patients by severe root resorption. To monitor apical root resorption the standard procedure is a radiographic examination after 6 months of treatment. In teeth with enhanced risk, a 3-month radiographic follow-up is recommended. The administration of anti-inflammatory drugs might suppress root resorption induced by orthodontic therapy, although none study was enough conclusive to indicate a protocol for patients with enhanced risk. In the event of multiple external root resorption, the diagnostic procedure should focus on the exclusion of the local factors and its associations (such as magnitude, duration and type of orthodontic force; periodontal disease; root form) that might lead to external root resorption. Systemic disorders associated with phosphorus-calcium metabolic alterations shall be suspected. This review searched the current knowledge of the mechanical and biological aspects of root resorption in orthodontic tooth movement. <![CDATA[Oral health knowledge, attitudes and practice in 12-year-old schoolchildren]]> Objective: The objective of this study was to assess the association between knowledge, attitudes and practice of oral health in 12-year-old schoolchildren, and to analyse the findings in terms of the conventional KAP health-education model and of the critical approach. Study design: This study has a cross sectional design. The study participants were 1105 randomly selected 12-year-old children resident in the region of Galicia in Spain. For data collection, five teams of one dentist and one assistant were formed. The dentist carried out the physical examination and the assistant helped the subjects to answer the questionnaire. Knowledge, attitudes and practice were assessed, as well as oral health indicators. Multiple regression analysis was used to identify variables affecting practice (as measured by extent of plaque). Results: The results of this study show how that there is an important association between oral health knowledge, attitudes, and practice in 12-year-old schoolchildren in this region. However, the results also show that attitude is not totally explained by knowledge, so that attitude cannot be understood simply as an intermediate variable in a knowledge® practice causal chain. Specifically, the results indicate that sociocultural environment modifies the association knowledge, attitudes and practice. Conclusions: Within oral health education it is clearly important to increase public knowledge of the risk factors for dental disease. However, the efficacy of such education will be limited if health programs do not directly impinge on attitudes, and take into account factors related to the environment, education, social status and economic level of the targeted population.