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Objectives: To investigate salivary biomarkers associated with bone remodeling and tissue repair in patients receiving radiotherapy. Study Design: Ethical approval (85229518.9.0000.5149). Patients previously subjected to radiotherapy of the head and neck were prospectively selected. Individuals who did not receive radiotherapy were paired by age and sex and composed the control group. Inclusion and exclusion criteria applied. Nonstimulated saliva was collected and processed for RANK, RANKL, OPG, endothelial growth factor (EGF), vascular endothelial growth factor (VEGF), and matrix metalloproteinase 9 (MMP-9) by enzyme-linked immunosorbent assay (ELISA). Paired t test and Wilcoxon test were used and P values .05). Patients receiving radiotherapy and chemotherapy (n = 16) had lower EGF than controls (P .05). Conclusion: Head and neck radiotherapy lowers the salivary concentrations of tissue repair factors, but not the bone remodeling factors. Support: CNPq, CAPES, FAPEMIG.

An 11-year-old patient, male, was submitted to orthodontic traction of enclosed lower molar. Tomographic examination showed a radiolucent image measuring approximately 1 cm between 46 and suggestive dental germ of the 47. Intraoral examination confirmed absence of the 46. The orthodontic traction was performed and a routine panoramic radiography revealed formation of a delineated radiolucent image with radiopaque foci at the periphery. Thereby, hypothesis of odontogenic lesions with a mixed radiographic appearance was made. A positive aspiration puncture for citrus yellow liquid was performed, followed by excisional biopsy. Microscopic findings revealed a cystic capsule lined by with odontogenic epithelium and numerous phantom cells permeated by areas of calcification. Moreover, the presence of dental tissues pointed to the diagnosis of calcifying odontogenic cyst associated with odontoma. Currently, the patient is in follow-up and radiographic images reveal new bone formation in the region. Financial support: CAPES.

A 63-year-old female patient was evaluated by the Stomatology Service for painful, infected lesions over a 6-month duration in the mandible and in the maxilla. The patient reported use of alendronate sodium once a week for 5 years, and tooth extraction in the region 1 year ago without healing. Intraoral examination showed an area of bone exposure with formation of bone sequestrum in the mandible and in the maxilla. Cone beam computed tomography revealed a well-defined hypodense image, delineated by a thin, hyperdense halo, without bone expansion, establishing an orosinus communication. The clinical diagnosis was osteonecrosis associated with an antiresorptive drug. The patient was treated by sequestrectomy, sinusotomy, and with a buccal fat pad and soft tissue flap for closure of the orosinus communication. The anatomopathologic examination of the bone fragment confirmed the diagnosis of osteonecrosis. The 18-month of follow-up demonstrates clinical and radiograph healing. Support: FAPEMIG.

A 64-year-old male patient presented an asymptomatic, long-lasting, submucosal enlargement at the right buccal mucosa. The lesion had a nodular appearance, was well circumscribed, was mobile, had a firm consistency, and was covered by clinically healthy mucosa. Ultrasonography revealed a hypoechoic, hypovascular, lobulated, and partially circumscribed lesion measuring 4.5 × 2.1 cm. The diagnostic hypotheses were epidermoid cyst or lipoma. The lesion was surgically excised under local anesthesia. During the excision, a dark-brown liquid drained out of the lesion. Histopathologic examination revealed a cystic lesion lined by a uniform, thin, parakeratinized epithelium with corrugated surface. The basal cell layer was hyperchromatic with nuclei palisade. The diagnosis was of odontogenic keratocyst. Panoramic radiograph revealed no bone involvement, and the patient showed no signs of Gorlin-Goltz syndrome. The patient is disease-free after 12 months of follow-up. Support: FAPEMIG.

A 7-year-old white male patient was referred to the stomatology and surgery service. Anamnesis and intraoral clinical examination revealed delayed eruption of teeth 36 and 46, facial symmetry, and bilateral pain. Imaging showed a lesion measuring 19 × 25 mm on the right and left sides, respectively; the lesions were radiolucent, unilocular, well-delimited areas involving the teeth 36 and 46. The aspiration puncture revealed citrus-like liquid, followed by incisional biopsy and marsupialization of the lesions. Histopathology revealed a connective tissue lined by simple or stratified squamous epithelium. The diagnosis was dentigerous cyst. After 1 year of conservative therapy and follow-up care, remission of the lesion and eruption of the teeth were noted. Support: FAPEMIG.

A 25-year-old black male patient presented with a chief complaint of asymptomatic swelling in the anterior maxilla and nasal deformation of 2 years’ duration. Intraoral examination showed a large increased volume in the hard palate extending to the right vestibular region of the maxilla, causing displacement of the nose wing and shortening of vestibular depth. Panoramic radiography revealed a radiolucent area in the maxilla causing displacement of tooth 11 and tooth 21. Needle aspiration revealed a darkened fluid. An incisional biopsy was done, and a cannula inserted into the cavity to enable cystic decompression. Pathologic examination revealed fragments of cystic cavity coated by either simple cuboidal or nonkeratinized squamous stratified epithelium. A capsule of fibrous connective tissue completes the picture with a diagnosis of nasopalatine duct cyst. After an 8-month period, a cystic enucleation was done. No evidence of recurrence was noted after 1-year of follow-up. Support: FAPEMIG.

An 81-year-old male patient was referred to the stomatology service complaining of difficulty in prosthesis adapting. Clinically, a painless swelling was evident in the left maxilla. An incisional biopsy was performed and the specimen sent for histopathologic examination, revealing a final diagnosis of ameloblastoma. A computerized tomography (CT) scan was performed, revealing an extensive left maxillary lesion, involving the maxillary sinus and nasal cavity, crossing the midline and extending to the right side. During surgical planning, the use of the Weber-Ferguson-Diffenbach approach was raised, but it would not allow the recommended resection of the lesion since it exceeded past the midline. So, a midfacial degloving approach was chosen because this allows complete resection with safety margin and a better aesthetic result. The patient recovered well with good healing; no signs of recurrence were noted after 1 year of follow-up care. Thus, the degloving approach should be taken into account when treating extensive lesions in the midface. Support: FAPEMIG.

A 20-year-old white man was referred to the oral medicine clinic, complaining of an asymptomatic swelling in the upper lip lasting for around 2 years. His medical history included stress-induced gastritis, bronchitis, allergic rhinitis, and episodes of facial paralysis. The extraoral examination showed a large and diffuse swelling affecting the upper lip vermillion and labial mucosa causing facial asymmetry. The lesion was nonpitting, had a rubbery consistency, and presented with a normal temperature. The vermillion border was dried and stretched, with no ulceration. The intraoral examination revealed deep grooves and fissures on the tongue dorsum. A previous biopsy of the lip showed a chronic inflammatory area. Based on the history and clinical features, the diagnosis of Melkersson-Rosenthal syndrome was made. The patient is under treatment with intralesional infiltration of triamcinolone acetonide in the upper lip. Moreover, he was referred for a physician to investigate a possible intestinal involvement. Support: FAPEMIG.

Patient C.C.F.S., a 39-year-old woman, went to the pathology and stomatology center for an evaluation of a lesion in the palate with more than 5 years of evolution. The anamnesis and intraoral examination revealed a well-defined tumor, fibrous consistency, and ulcerated surface in the posterior region of the hard palate on the left side. Ulceration resulted from the drainage attempt by the physician who referred it supposing to be an odontogenic lesion. An incisional biopsy was performed. Histopathologic evaluation revealed capsular tissue surrounding the periphery; neoplastic cells arranged in cords and nests, and ductal structures filled by mucoid content interspersed by hyalinized connective tissue. Treatment consisted of surgical excision and use of an acetate plate in the postoperative period because of the risk of bucosinusal communication evidenced by the tomography. The staining of the edges of the surgical specimen showed that they were free of neoplastic cells. The patient has been followed up for 8 months.

Pycnodysostosis (PYCD) is a rare autosomal recessive disease occurring due to a mutation in the gene that codes for the enzyme cathepsin K. Osteomyelitis of the jaws is a common complication of the PYCD. A 30-year-old female patient with PYCD presented with mandibular osteomyelitis which was treated by sequestrectomy and with a buccal fat pad as free graft (BFPFG) to fill the bone defect. The 24-month of follow-up demonstrates clinical and radiographic healing. A literature search was undertaken in Medline (through PubMed) in March of 2018 on PYCD case reports. Seventeen contributions were included in this study and discussed. To the best of our knowledge, this is the first case using BFPFG in the management of osteomyelitis of the jaws in a patient with PYCD. Despite the good results, further studies using BFPFG as adjuvant therapy for the management of jaw osteomyelitis are necessary to elucidate its clinical efficiency and safety. Support: FAPEMIG.