Jordi | Journal of Oral Diagnosis Online Submission Review an Article SOBEP - Sociedade Brasileira de Estomatologia e Patologia Oral
Current Number: V3 - 2018

Case Report

1 - Oral leiomyoma: A case report on a rare lesion in oral cavity

Pratibha S Sharma1; Venkatesh G Naikmasur2; Kirty R Nandimath2; Krishna N Burde3; Veda Hegde4; Venkatesh Anehosur5

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INTRODUCTION: Leiomyoma, a benign tumour of smooth muscles, often affects uterine myometrium, GIT, skin and lower extremities of women of middle age group. Its occurrence in oral cavity is quite rare with reported incidence of 0.065%. It is contemplated that in oral cavity leiomyoma arise from smooth muscle wall of blood vessels chiefly affecting lips, tongue, palate, buccal mucosa, and rarely gingiva and mandible. Clinically the disease exhibits as a slow growing asymptomatic mass, occasionally associated with pain. Histopathological study is mandatory to help determine the diagnosis due to deceptive clinical appearance. Surgical excision is widely accepted as the best treatment modality with rare recurrence. OBJECTIVE: The rationale of this case report is to help improve our understanding of this rare disease (oral leiomyoma) and to report its occurrence in the literature. CASE REPORT: We report a rare case of a 25 years old female patient presenting with the chief complaint of a slow growing mass since 6 months, diagnosed as leiomyoma after clinical and histopathological examination. CONCLUSION: Leiomyoma is a benign tumour of smooth muscles with rare presentation in the oral cavity with good prognosis. Due to deceptive clinical and histopathological characteristics it is important to meticulously evaluate clinically and histopathologically to arrive at conclusive diagnosis.

Keywords: Leiomyoma; Mouth Mucosa; Smooth Muscle Tumor..

2 - Aggressive adenomatoid odontogenic tumor: an uncommon case report and discussion on the differential diagnosis

John Lennon Silva Cunha1; Juliana Batista Melo da Fonte2; Maria de Fátima Batista de-Melo2; Rose Nely Pereira Filho1; Ricardo Luiz Cavalcanti de Albuquerque Júnior1

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Differential diagnosis between ameloblastomas (AMB) and adenomatoid odontogenic tumor (AOT) seldom cause difficulties due to classic histopathological presentations. Adenoid ameloblastoma with dentinoid (AAD) is a rare variant of AMB which can be misdiagnosed as AOT. We report a case of a 12-year-old female presenting a painless swelling in the anterior region of the mandible. Panoramic radiograph and cone beam CT scans demonstrated large unilocular osteolytic lesion extending from 44 to 32 and involving the impacted 43. Tumor caused teeth displacement and both vestibular and lingual cortical perforation. Histopathology revealed cuboidal and spindle-shaped cells arranged in nests and rosettes, solid, duct-like and whorled areas, and foci of calcification and dentin-like material were evident. The diagnosis was aggressive AOT. Because of the similarities of the histologic features of AOT and AAD, we intend to provide a discussion on the clinicopathologic criteria for establishing the differential diagnosis of these entities

Keywords: Ameloblastoma; Diagnosis, Differential; Mandible..

3 - Mucous retention cyst in maxillary sinus with expansion of maxillary tuberosity: case Report

Renato Garcia Mattos1; Lais Sara Egas2; Priscila Carneiro Oliveira3; Ana Paula Farnezi Bassi2; Francisley Ávila Souza2; Daniela Ponzoni2

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Mucosal retention cyst in the maxillary sinus is a benign entity that results from obstruction and dilation of seromucous glands ducts due to inflammation, infection or reaction of maxillary sinus mucosa to allergic processes. It is an asymptomatic lesion, usually identified in routine imaging tests requested by professionals. The present study aims to present a case of maxillary sinus mucosal retention cyst in a 63 years old patient who reported difficulty in adapting her total upper prosthesis and persistent pain in the left maxilla. The treatment was surgical enucleation.

Keywords: Retention cyst; Maxillary sinus; Oral diagnosis; Enucleation..

Original Article

4 - Prospective evaluation of the sialoadenectomy as treatment for giant sialolith in the submandibular gland: Case series

Jonathan Ribeiro da-Silva1; João Paulo Bonardi1; Rodrigo dos Santos Pereira1; Camila Albuquerque3; Hernando Valentim da-Rocha-Júnior2; Eduardo Hochuli-Vieira1

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OBJECTIVE: The objective of this study is to report a series of cases of giant submandibular gland sialoliths treated by sialoadenectomy. METHODS: Nine patients were admitted to the Maxillofacial Surgery Department of Nova Iguaçu General Hospital from 01/01/2012 to 01/05/16, presenting submandibular gland sialoliths larger than 1.5 cm without response to conservative treatment. All patients underwent sialoadenectomy through cervical access. RESULTS: Patients presented a mean age of 51 years, with 7 being male and 2 being female. The size of the sialoliths removed ranged from 1.8 to 4.9 cm. None of the patients presented hypoglossal nerve complications, 2 had transitory marginal mandibular nerve palsy, and 2 patients had postoperative infections in the first week. CONCLUSION: We can conclude that giant sialoliths represent a greater difficulty for the treatment of sialolithiasis, where sialoadenectomy represents a resolutive therapy with few complications.

Keywords: Submandibular Gland Diseases; Calculi; Surgery, Oral.

5 - Salivary flow rate response to stimulation with 2% citric acid in patients with xerostomia

Juan Aitken Saavedra1,2,3; Rodrigo Ponce Muñoz1; Gonzalo Rojas Alcayaga1; Sandra Chaves Tarquinio2,3; Karine Duarte da-Silva2,3; Ricardo Fernandez Ramires1; Irene Morales Bozo4

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OBJECTIVE: Xerostomia is the subjective sensation of dry mouth and it can be an indicator of hyposalivation what would have clinical consequences like increased risk of the development of oral diseases. For this reason, the stimulation of salivary flow with organic acids, such as citric acid, must be considered as a treatment strategy for xerostomic patients with hyposalivation. This study aimed to determine the salivary responses of patients with xerostomia to stimulation on the tongue with 2% citric acid. MATERIAL AND METHODS: This study recruited 62 patients with xerostomia. The differences in salivary flow rate (SFR), pH, and buffer capacity values were determined before and after 1, 2, 3, 5, 7, 9, 11, 13, or 15 min of stimulation on the tongue with 2% citric acid. RESULTS: Among the recruited patients, 92% were women and 53% had hyposalivation. The average age of the recruited patients was 55 years. The mean basal SFR value was 0.282 ml/min (DS 0.305). SFR (p=0.001) increased and pH (p=0.000) and buffering capacity (p=0.000) decreased at 1 min poststimulation relative their basal values. The values of the three parameters stabilized at 2 min poststimulation and remained constant until the end of the measurement period. CONCLUSION: Citric acid could be used to stimulate salivary flow in xerostomic patients with hyposalivation maintaining salivary pH values and buffering capacity within an acceptable range. However, to be considered a possible therapy for this kind of patients, it is still necessary to perform more studies.

Keywords: Xerostomia; Tongue; Citric Acid.

Case Report

6 - Adenomatoid odontogenic tumor: an unusual histological presentation with "Pindborg-like" differentiation

John Lennon Silva Cunha1; Amanda Feitoza da Silva1; Juliana Batista Melo da-Fonte2; Raimundo Silva Rocha1; Maria de Fátima Batista de-Melo2; Ricardo Luiz Cavalcanti de Albuquerque-Júnior3

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Adenomatoid odontogenic tumor (AOT) is a relatively rare odontogenic tumor derived from odontogenic epithelium. Although there have been many reports regarding the histological spectrum of AOT, only a few have highlighted unusual histological presentations. A 28-year-old female presented with a painless swelling in the maxillary anterior region. Radiological examinations revealed a well-defined unilocular lesion, with sclerotic margins, containing foci of slightly radiopaque material and promoting root divergence between teeth 22 and 23. An incisional biopsy showed spindle-shaped cells forming sheets, strands, and whorled masses, together with ductlike structures, throughout a scanty fibrous stroma. In some areas, sheets of polyhedral epithelial cells with prominent intercellular bridges, mild pleomorphism, and droplets of amyloidlike material were observed. The diagnosis was AOT with "Pindborg-like" differentiation. The occurrence of such differentiation in AOT seems to represent the caricatures of the enamel organ itself and is believed to be an altered phenotype of the tumor.

Keywords: Odontogenic Tumors; Maxilla; Neoplasms..

7 - A rare case of enamel pearl in canine tooth

Ana Carolina Ramos Mariz1; Gabriela Meyge de Brito2; Daniela Adorno Farias3; André Wilson Machado2; Paulo Sérgio Flores Campos1

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The enamel pearl (EP) is a dental developmental anomaly that usually manifests in furcation areas, and is uncommon in uniradicular teeth. We present a case of EP on the vestibular surface of tooth 13 in a 38-year-old patient, who was submitted to multislice computed tomography (MSCT) for orthognathic surgery planning. The attenuation coefficient (3.070 HU) allowed the condition to be classified as a true EP.

Keywords: Tooth Abnormalities; Multidetector Computed Tomography; Tooth, Impacted.

8 - Importance of correct management of bisphosphonate-related osteonecrosis of the jaw: case report and literature review

Cristianne Kalinne Santos Medeiros;Hellen Bandeira de Pontes Santos; Larissa Santos Amaral Rolim; Antonio Bruno Gomes Mororó; Adriano Rocha Germano; Ana Miryam Costa de Medeiros; Patrícia Teixeira de Oliveira

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INTRODUCTION: Osteonecrosis results from local and systemic factors that compromise blood flow in bone tissues, being relatively frequent in maxillary bones. In recent years, there has been an increase in the incidence of new cases of medication-related osteonecrosis of the jaw (MRONJ). OBJECTIVE: The aim of this study is to report a case of hard palate osteonecrosis associated with the use of bisphosphonate and to review the literature on the major clinical features, diagnosis, and management of this disorder. CASE REPORT: An 84-year-old female patient presented with a lesion to the midline of the hard palate with exposed necrotic bone. Family members reported that the patient had been on ibandronate sodium for nearly 5 years. Based on clinical and radiographic findings, the diagnosis indicated MRONJ. The patient underwent a surgical procedure for debridement of necrotic bone and closure of the exposed tissue by means of Z-plasty. After a 4-month follow-up, there were no clinical and radiographic signs of recurrence. CONCLUSION: The present case and the literature highlight the importance of proper anamnesis combined with clinical, radiographic, and laboratory findings to make an accurate diagnosis in order to provide the best therapeutic approach. In addition, the importance of dental surgeons knowledge aboutthe association between bisphosphonate therapy and osteonecrosis is very important, given the several indications of this drug and, thus, the high probability of attending to patients treated with this medication, with the aim of reducing the occurrence of new cases of MRONJ and, consequently, morbidities and their aggravation.

Keywords: Bisphosphonate-associated osteonecrosis of the jaw; Osteonecrosis; Diagnosis; Treatment Outcome.

9 - Uncommon presentation of an intraosseous squamous cell carcinoma

Leorik Pereira da-Silva1; Amanda Katarinny Goes Gonzaga1; Luciana Eloisa da Silva Castro-Nóbrega1; Adriano Rocha Germano2; Antonio de Lisboa Lopes Costa1

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Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare type of cancer, which commonly arises in the jaw without attachment to the oral mucosa epithelium and presumably develops from remnants of odontogenic epithelium or from odontogenic cysts and odontogenic benign tumors. We report here a case of a 49-year-old male patient who presented pain in the teeth 44 and 45 region. Radiographic examination revealed a small radiolucent and well circumscribed lesion, however, histopathological examination revealed a PISCC. The clinical and radiographic presentation of this tumor can be variable and nonspecific, and even small osteolytic lesions in the gnathic bones can be considered as differential diagnosis of malignant neoplasms of odontogenic origin. Incisional biopsy is fundamental to lead to early diagnosis and indicate appropriate treatment to optimize the prognosis of these cases.

Keywords: immunohistochemistry; Mouth Neoplasms; Carcinoma, Squamous Cell.

Review Article

10 - The role of pleomorphic adenoma stroma on its neoplastic progression: state of art

Flávia Godinho Costa Wanderley Rocha1; Roberto Paulo Correia de Araújo2; Gabriela Botelho Martins3; Alena Ribeiro Alves Peixoto Medrado4

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The tumor development is linked to its stroma. The study of tumor stromal cells enables the understanding of the neoplastic progression. The present narrative literature review aimed to describe tumor stromal cells, such as endothelial and inflammatory cells, that may induce the neoplastic progression of pleomorphic adenomas. The Latin American and Caribbean Center on Health Sciences Information (BIREME) and PubMed electronic databases were searched for scientific articles on this subject published in Portuguese and English from 2007 to 2017. The search focused on information about the clinical, imaging, and anatomopathological characteristics of pleomorphic adenomas and its neoplastic progression. After analyzing abstracts and reading the cataloged manuscripts, 44 articles were selected. It was shown that the tumor stroma is important for neoplastic progression by providing elastic properties to the tumor and by enabling its nutrition. Thus, it is relevant to study the cellular and molecular mechanisms that occur in extracellular matrix in order to understand the biological behavior of pleomorphic adenoma.

Keywords: Extracellular Matrix; Neoplasm; Pleomorphic Adenoma.

Case Report

11 - Bullous disease after dental implant placement procedure: a case report highlighting clinical aspects

Gerardo Marcelo Gilligan1; María Fernanda Galíndez-Costa1; Lorena Moine1; Gabriela Sambuelli2; René Luis Panico1

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IgA bullous dermatosis (LIgAD) is an uncommon diagnosis in Oral Medicine. The LIgAD-associated oral mucosa involvement was previously described by other authors and the clinical presentation is similar to other bullous diseases such as Pemphigus Vulgaris or other subtypes of Pemphigoids. The aim of this work is to report a case of a 63-years-old male who consulted for several painfully bullous lesions related to a story of non-treated cutaneous and ocular lesions. The patient referred the begin of the disease after a dental implant surgery procedure. The Direct Immunofluorescence allowed to show an IgA deposit in a linear pattern throughout the base membrane zone. After diagnosis, a corticosteroid treatment was applied with a huge improvement and healing of the lesions. This is the first case described in current literature of a rare bullous entity associated with a dental implant placement procedure. Since there was described several trigger factors related to dental practice, there should be more reports of these cases highlighting clinical presentation, therapeutic management and probable trigger factors for this entity.

Keywords: Linear IgA Bullous Dermatosis; Skin Diseases, Vesiculobullous; Dental Implants; Risk Factors.

12 - Chondroblastic osteosarcoma of the maxilla: diagnostic challenges on incisional biopsy and report of a case

Lara Cristina Oliver Gimenez1; Bruno Tavares Sedassari1; Cibele Pidorodeski Nagano2; André Caroli Rocha3; Suzana Cantanhede Orsini Machado de Sousa1; Décio dos Santos Pinto-Júnior1

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Osteosarcoma is a rare mesenchymal neoplasm characterized by osteoid production. Its neoplastic cells can synthesize variable kinds of matrix which determines the sub types as the chondroblastic variant and its cartilaginous matrix. We report a case of a 30-year-old man who presented a painful swelling in the right posterior maxilla, associated to teeth mobility. Radiographic exam showed bone rarefaction with poorly defined margins and root resorption in the corresponding area. An incisional biopsy was performed and histopathologic examination revealed proliferation of mesenchymal spindle-shaped cells in a stroma with irregular, immature and basophilic cartilaginous tissue without osteoid tissue. The cell were diffusely positive for S100 protein. A provisional diagnosis of chondrosarcoma was rendered until the excisional biopsy revealed the presence of osteoid tissue possibiliting a final diagnosis of chondroblastic osteosarcoma. Differentiating between chondrosarcoma and chondroblastic osteosarcoma in incisional biopsies may be a hard task when material is scarce, often incurring in the need for further biopsy. Correct diagnosis is essential for the correct treatment.

Keywords: Osteosarcoma; Chondrosarcoma; Diagnosis, Differential..

13 - Critical appraisal of determinant factors of an extensive oral squamous cell carcinoma - Report of case

Natália Batista Daroit1,2; Monique Santanna Candreva2; Nathália de Almeida Freire2; Sarah Aparecida Ferreira Antero2; Pantelis Varvaki Rados1; Mônica Simões Israel2

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INTRODUCTION: Oral squamous cell carcinoma (OSCC) is the most frequently occurring oral malignant neoplasm. Early diagnosis is essential for determining the treatment and prognosis of OSCC. OBJECTIVE: The aim of this study was to report a case of an extensive OSCC, to discuss factors involved in the diagnosis of advanced lesions and to clarify difficulties experienced in referring patients with OSCC for treatment to a healthcare system. METHODS: The study included male patients aged 50 years who were chronic alcoholic and tobacco smokers, who had severe trismus, and who presented with ulceroproliferative growth with indurated raised margins, involving the left palate and lower gingiva, extending into the buccal mucosa, and overlying the skin. RESULTS: An incisional biopsy confirmed the diagnosis of OSCC, and the patient was referred for treatment. CONCLUSIONS: The factors that delay the diagnosis of OSCCs are misinformation, self-care negligence, socioeconomic aspects, inappropriate oral mucosa examinations, unknown oral diseases, and failure to obtain a conclusive diagnosis and forwarding the patient to the treatment.

Keywords: Mouth Neoplasms; Risk Factors; Diagnosis..

14 - Metastatic colorectal adenocarcinoma in oral cavity: case report and Literature review

Cibele Pelissari1; Desiree Cavalcanti2,3; Paulo Henrique Braz-Silva1; Marina Gallottini1; Marília Trierveiler1

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Metastatic neoplasms of maxillary bones are rare and may exhibit symptoms of diseases of dental origin. The colorectal adenocarcinoma is one of the most common malignancies in the world and most predominantly metastasises to the liver and the lungs. We present a case report of metastatic colorectal adenocarcinoma in the mandible of a 64-year-old white female. The patient was referred to a stomatology service complaining of intense oral pain for 5 months. Her medical history revealed evidence of treatment for colorectal adenocarcinoma 3 years prior to this investigation. On clinical examination, a painful inflamed gingival overgrowth was discovered covering the space in which a tooth extraction had been undergone previously. To provide a diagnosis for this, biopsy and imaging studies were undertaken. Histology sections revealed a malignant neoplasm of glandular epithelial differentiation, characterized by proliferation of tall columnar neoplastic cells, organized in tubular structures of a single layer, characterizing metastatic colorectal adenocarcinoma. The patient received palliative chemotherapy but died of the disease 6 months after. In conclusion, despite the rarity of metastasis of the jaw, this condition should be considered and investigated, especially in patients with oral symptoms and history of malignancies

Keywords: Neoplasm Metastasis; Colorectal Neoplasms; Adenocarcinoma.

15 - Surgical treatment of orthokeratinized odontogenic cyst in maxillary sinus: Case report in pediatric patient

Antonio Dionízio Albuquerque-Neto1; Lorenzzo De Angelli Cesconetto1; Daniel Assunção Cerqueira1; André Victor Alves Araujo1; Vinicius Dantas Oliveira1; Eder Magno Ferreira Oliveira2

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The orthokeratinized odontogenic cyst is a rare developmental cyst that affects the jaws. Since 2017 it has been classified as an independent entity of odontogenic keratocyst, since it presents differences in its biological behavior, histopathological aspects, as well as less aggressiveness and potential for recurrence. It affects young individuals, with predominance for the masculine gender. Their behavior is not aggressive, but can reach large proportions. The present case reported, in a male patient, 9 years old, with an expansive osteolytic process of large proportions was observed, taking all the extension of the left maxillary sinus. The patient was submitted to enucleation of the lesion under general anesthesia, is being followed up without signs of relapse.

Keywords: Bone Cysts; Pathology, Oral; Maxillary Sinus..

Original Article

16 - Foramen of Huschke persistence in Brazilian adult temporal bones: a morphometric study

Wagner Gomes da-Silva1; Amanda Barreto Ramos1; Bianca Silva Gomes1; Deise Caldas Kühlman1; José Gabriel Chávez1; Luciana Quintanilha Pires Fernandes1; Henrique Ayres de-Vasconcellos2,3

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Foramen of Huschke (FH) is a normal anatomical structure performed until the total maturation of the cranium skeleton, which obliterates by a natural process about the 5-year-old. However, it may persist in adult life and can be rarely associated with complications in the temporomandibular joint (TMJ) and external auditory canal apparatus as well as a higher risk of tympanic injury during surgical procedures such as TMJ arthroscopy. The aim of this study was to report the prevalence and morphometric features of persistent FH in a Brazilian adult temporal bones sample. The methods included an anatomic and morphometric analysis of 146 dried temporal bones obtained from adult cadavers. Twenty-two (15.0%) of the temporal bones presented persistent FH. Unilateral FH accounted for 4 (30.8%) and bilateral foramens for 18 (69.2%) of the 13 affected craniums. Forms varied, including 2 (7.8%) circular, 12 (46.1%) oval and 12 (46.1%) irregular FH. Ten (45.4%) of the temporal bones presenting FH were observed in the right side and 12 (54.6%) in the left. Mean size of FH was 3,00 mm in the transversal and 2,52 mm in the longitudinal axis. Additionally, the mean anterior and posterior distances from two adjacent anatomical structures, petrotympanic fissure, and styloid process were 4,23 mm and 9,9 mm respectively. In conclusion, there seemed to be a considerable morphological heterogeneity when comparing the persistent FH specimens. We, additionally, highlight the importance of clinicians and oral and maxillofacial surgeons know this condition and its anatomical implications.

Keywords: Temporal bone; Temporomandibular joint; Ear Canal; Anatomy.

Case Report

17 - Phenotype of cleft lip and palate and other oral manifestations in individuals from the same family - Case reports

Lúcia Rosa Reis de Araújo Carvalho 1; Markelane Santana Silva 2; Heloísa Clara Santos Sousa 2; Raimundo Rosendo Prado Junior 2; Regina Ferraz Mendes 2

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We aim to describe the oral phenotype and manifestations of the cleft lip and palate of individuals from two generations of a family. The family history, information relating to pregnancies, sociodemographic data and pre- and postoperative clinical and radiographic characteristics of the individuals were collected. Four members of the family had cleft lip and palate: the father and three daughters. They had different phenotypes regarding their type and affected side. The individuals underwent medical treatment and received surgical correction procedures. Alteration in the number, shape, positioning and eruption pattern of teeth was registered. The presence of oral clefts between generations of the same family is not a predictable phenomenon nor are their characteristics. Reports of this nature, as well as the psychological and social impact of the condition, are important to emphasize the need aspects of studies involving these individuals.

Keywords: Cleft Palate; Pathology, Oral; Tooth Eruption; Reconstructive Surgical Procedures..

18 - Clinical management of self-mutilation in a neurologically compromised patient under intensive care: A case report

Germano Angarani; Angela Beatriz Cavalcante de Amorim Izac; Alessandra Dias Lemes Guerra; Ruben de Morais Carrijo; Rubens Jorge Silveira

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INTRODUCTION: Muscular control is a challenging task for neurologically compromised patients. In certain circumstances, tongue protrusion combined with trismus may lead to severe intraoral injuries. OBJECTIVE: To report a case of self-mutilation of the tongue in a patient with cerebrovascular accident. CASE REPORT: A 60-year-old female patient under treatment in the intensive care unit presented a lesion on the lower surface of the tongue caused by the adjacent teeth. A low-cost intraoral device was developed using thermoplastic (70°-75°C) impression material (Aquaplast 3.2 mm, Aquaplast Corp. Wyckoff, NJ, USA). In general, this material is used to build orthopedic appliances and may adapt to the patient with no need for laboratory procedures. Additionally, the material has moderate resistance, full-memory and good remodeling for dynamic conditions. CONCLUSION: The device developed in the present case was very effective to protect the teeth and avoid further episodes of self-mutilation. Other studies are necessary to test this device and alternative materials for the protection of intraoral hard and soft tissues.

Keywords: Bite; Injury; Intensive Care; Neurological Disorders; Tongue..

19 - Presentation of a clinic case: asymptomatic rhinolithiasis in a nine-year-old chid

Yanne Mendes; Elaine Oliveira Sales; Lígia Oliveira Polizzi; Luciene Dornas Mendes; Alexandre Camisassa Diniz Leite Greco; Carolina Drumond de Barros e Azevedo; Flávio Ricardo Manzi

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INTRODUCTION: Rhinolith is a petrea formation, relatively uncommon, which develops itself in the nasal cavity and it is rarely asymptomatic. It is formed from the deposition of organic and inorganic compounds,on a foreign body and it can initiate symptoms like runny nose, nasal obstruction, foul odor and epistaxis. As the rhinolith has evoluted, it can bring more grave complications as oronasal perforation and nasal septum deviation. The choice treatment is usually based on the surgical removal of the calcified mass. OBJETIVE: This study aims at relating a rare case of asymptomatic rhinolithiasis accidentally diagnosed in the left nasal cavity of a 9-year-old child. CASE REPORT: Male patient, 9 years old, under a dental treatment was sent by the clinician for the image exams achievement aiming at visualizing a supernumerary tooth located on the anterior maxilla region promoting the 21 dental tooth migration. The patient was subjected to a Computed Tomography Cone Beam. It was observed, on this exam, the presence of a supernumerary tooth in formation, a calcified mass on nasal cavitys upper third on the left side, with dimensions of 1cm width and 1,5 cm height and depth, promoting partial obstruction of oropharynx on the left side. It was also observed, adenoid hypertrophy. CONCLUSIONS: The case related showed how important are the image exams to do the precise diagnosis on this pathology, in order not to pass unnoticed during many years, thus leading the patient future serious complications. The recognition of this entity in routine radiographs exams, by the dental surgeon it is of a great importance for to the precosis diagnosis and tratment.

Keywords: Nasal Cavity; Sinusitis; Diagnostic Imaging..

Original Article

20 - Acne calcified scars: Case report

Mara Aparecida Barbosa de Sá; Natália Myrra Simões; Eduardo Silveira Rodrigues; Claudia Assunção e Alves Cardoso; Amaro Ilidio Vespasiano Silva; Flávio Ricardo Manzi

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INTRODUCTION: The involvement of calcium regulatory factors in the epithelial tissue can result in calcification or cutaneous ossification. The secondary osteomas, wherein the calcification develops in a preexisting skin lesions such as acne, for example, are the most common. OBJECTIVE: To report a case of calcification/ossification of soft tissues compatible with acne scarring. CASE REPORT: Panoramic panoramic radiographic examination revealed radiopaque, circular image in the alveolar ridge region in the air corresponding to tooth 36, with residual root characteristics . The alteration in the diagnostic hypothesis occurred after periapical radiography, which revealed a displacement of the radiopaque image to the upper region of the border, confirmed by another radiograph with a film placed in the position between the vestibular face of the alveolar border and the mucosa of the cheek. CONCLUSION: The radiographic findings associated with anamnesis and clinical examination suggested a diagnosis ofcalcification/ossification in soft tissue compatible with the healing of acne.

Keywords: Calcinosis; Ossification, Heterotopic; Acne Vulgaris.

Case Report

21 - Leiomyoma with intracytoplasmic inclusion bodies in the oral cavity: an uncommon histological finding

Denise Hélen Imaculada1; Pereira de Oliveira1; Marcelo Anderson Barbosa Nascimento2; Lélia Maria Guedes Queiroz2; Leão Pereira Pinto2; Lélia Batista de Souza2

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Leiomyomas are benign tumors that arise from the smooth musculature and can occur in any part of the body where these muscles are present. However, leiomyomas of the oral cavity are rare because of the scarcity of smooth muscles at this site. We present a case of leiomyoma involving the tongue which exhibited a histological finding that is extremely rare in oral leiomyomas. Immunohistochemical analysis revealed positivity for smooth muscle actin (alfa - SMA, desmin) and negativity for S - 100, CD- 68 and CD34 protein. The main clinical and histopathological features of leiomyomas, as well as their differential diagnosis, were reviewed. Intracytoplasmic inclusion bodies have been found in uterine leiomyomas, in atypical (bizarre) leiomyomas and, occasionally, in epithelioid leiomyomas and leiomyosarcomas. However, a search of the main literature databases revealed no description of these inclusions in oral leiomyomas.

Keywords: Leiomyoma; Inclusion Bodies; Mouth.

22 - Case report: tongue squamous cell carcinoma after renal transplantation

Suellen Vieira do Nascimento1; Adriana Furtado de Macedo2; Cynthia Larissa Cordeiro de Souza1; José Osmar Medina Pestana3; Yuri Kalinin4; Denise Caluta Abranches1

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The continuous immunosuppression of patients undergoing solid organ transplantation leaves them susceptible to the development of a wide variety of neoplasias, increasing their risk in relation to the general population. The present article presents a case report of squamous cell carcinoma in the tongue of a 57 year-old man fifteen years after a live donor kidney transplant. In use of several medications, he presented several comorbidities in the post-transplant period. One of these, Kaposi's sarcoma, is quite common in organ transplanted individuals associated with HHV-8. In this specific case, the neoplasia had the oral cavity as the primary site and the Oral Medicine team had an important role in the diagnosis of the lesion and treatment of its comorbidities, and this care was the motivation of this article.

Keywords: Carcinoma, Squamous Cell; Tongue; Immunosuppression (Physiology); Kidney Transplantation; Oncogenic Viruses; Oral Medicine.



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