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Os sialolitos são estruturas calcificadas que se desenvolvem dentro dos ductos salivares. A hipótese mais aceita é da deposição de sais de cálcio ao redor de um foco de detritos na luz do ducto. A sialolitíase não tem predileção por raça e é mais comum em adultos de meia idade do sexo masculino, sendo a glândula submandibular a mais acometida. O diagnóstico é realizado por meio de exame clínico e de imagem; já o tratamento depende do tamanho e da localização do sialolito, podendo variar de estimulação salivar até sua remoção cirúrgica, com ou sem a glândula envolvida. Sendo assim, alguns relatos na literatura reportam a importância do reparo ductal, evitando complicações como fístula, estenose e fibrose. Desse modo, o presente relato apresenta um caso clínico bem-sucedido da excisão cirúrgica por acesso intrabucal de sialolito no ducto de Wharton, utilizando um cateter em PVC, que foi instalado e suturado à mucosa. Essa conduta resultou na comunicação da luz do ducto com o meio externo, mantendo sua continuidade, evitando seu colabamento e, consequentemente, promovendo a formação de um novo óstio ductal. Conclui-se que a presente técnica, trouxe um pós-operatório confortável, com remissão de sintomatologia e restauração da função glandular.

Aspergillosis, aka fungal ball (FB), is classified as a type of non-invasive fungal rhinosinusitis, which usually occurs unilaterally in the maxillary sinus of an immunocompromised patient. Its diagnosis is complex and depends on the association between clinical, imaging, and histopathological exams. There are many treatments for fungal infections of the paranasal sinuses, so early diagnosis is extremely important to determine the appropriate treatment. This paper reports an unusual clinical case of aspergillosis present bilaterally inside the maxillary sinuses of a healthy patient, associated with mucous retention cysts, whose imaging exams and transnasal endoscopy were not sufficient to precisely identify the lesion. Its diagnosis and definitive treatment were obtained only after orthognathic surgery and integration between a multidisciplinary team. Key words:Aspergillosis, communicable diseases, fungal ball, infectious disease, orthognathic surgery.

Introdução: Infecções maxilofaciais em pacientes pediátricos são condições graves, caracterizadas pela disseminação do processo infeccioso aos tecidos adjacentes, com origem geralmente odontogênica. Objetivo: O objetivo do presente estudo foi ava- liar dados referentes às causas, características e tratamento realizado em pacientes pediátricos com infecção maxilofacial atendidos por um serviço de Cirurgia e Traumatologia Bucomaxilofacial em Maringá/PR, no período de 2007 a 2017. Métodos: A metodologia utilizada foi a análise retrospectiva dos prontuários, com o auxílio de um formulário estruturado. O formulário da pesquisa considerou as variáveis ida- de, sexo, temperatura de admissão, dente acometido, duração da infecção, terapia e prognóstico. Resultados: Como resultados, observou-se uma pequena predileção pelo sexo masculino (52,2%); a idade média encontrada foi de 7,3 anos; os dentes mais acometidos foram os primeiros molares decíduos inferiores (#75 e #85); a etiologia mais comum foi o acometimento pulpar por cárie; a temperatura de admissão média foi de 37,9oC; e as infecções duraram, em média, 3 dias. Com relação à terapia aplicada, o antibiótico mais utilizado foi a Amoxicilina e a conduta foi a drenagem do abscesso e o tratamento endodôntico. Conclusão: Faz-se necessário o conhecimento acerca dessa temática pelo cirurgião-dentista, visto que os pacientes pediátricos se tornam sistemicamente afetados muito rapidamente.

Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.

Paracoccidioidomycosis is an infectious disease caused by Paracoccidioides brasiliensis and is endemic in South America. A patient can be infected via fungus inhalation in the mycelium phase. Oral manifestations of paracoccidioidomycosis are often the first clinical sign of disease, but their appearance can vary. As a result, many clinicians are unable to identify this infection early. Late diagnosis can result in serious complications, such as pulmonary changes, or even death. This article reports 2 cases of paracoccidioidomycosis with different oral manifestations, reviews the literature, and discusses the various appearances of this infection and its differential diagnoses in order to emphasize the importance of performing a detailed clinical examination to make an accurate diagnosis and refer the patient for appropriate treatment.

Osteochondroma is a common benign bone tumor and although its involvement in facial bones is rare (0.6 %), it shows a strong predilection for developing in the mandibular condyle, causing occlusal changes and facial asymmetry. The aim of this study was to report a clinical case and the treatment of a 43-year-old male patient, who was diagnosed with condylar osteochondroma. Clinically, the patient presented an increase in volume in the right condylar region, deviation of the mandible to the left side and malocclusion. His main complaint was his facial asymmetry. Imaging exams showed changes in the size and morphology of the right condyle, and signs of hyper-capture on scintigraphy. The hypothesis of condylar hyperplasia and osteochondroma was raised. A virtual planning and execution of an orthognathic surgery of the jaws was performed to correct the occlusion and facial asymmetry, besides a low condylectomy to remove the lesion. Procedures such as high, low, proportional condylectomy, orthognathic surgery and TMJ reconstructive surgery are alternatives for the treatment of these pathologies. In our case, the orthognathic surgery combined with a condylectomy proved to be promising, to correct the occlusion and the facial asymmetry of the patient.

The nasopalatine duct cyst presents as a cyst of non-odontogenic origin, whose etiology has not yet been defined. However is believed in the theory of the proliferation of embryonic remains of the nasopalatine duct that leads to its formation. It is often detected in routine radiological examinations, which shows characteristics of a radiolucent lesion, defined, with a radiopaque halo, with a heart format due to overlapping of the anterior nasal spine. Because of this, it can be easily confused with an inflammatory periapical cyst from the upper central incisors. Besides, clinically the patient may complain of pain and swelling in the anterior region of the hard palate. The pain, pus, and swelling are usually associated with secondary infection. The present study aims to report a successful clinical case, of the diagnosis of a nasopalatine duct cyst, where the pulp sensitivity test and computed tomography helped in the treatment, that consisted in palatal access and total enucleation of the lesion. The recurrence of this cyst is low and usually affects adults from the fourth to the sixth decade of life. Treatment consists of total enucleation for small cysts or marsupialization followed by enucleation for larger cysts. This way, the imaging exams, and the clinical exam assist in the correct diagnosis, enabling the correct treatment. In our case, the total enucleation of the lesion was satisfactory, since, it did not cause damage to the adjacent structures and was the definitive treatment in only one surgical time. The patient continues been followed up, not showing symptoms or recurrence.

The aim of the present study was to evaluate the efficacy of Passiflora incarnata L for the control of anxiety during third mandibular molar extraction and compare it to midazolam, the most used benzodiazepine in dentistry.The investigators implemented a prospective, randomized, double-blind, split-mouth study. The degree of anxiety of the patients was assessed before the surgical procedure. The surgeries took place in two sessions: one on each side of the hemi-mandible and, on each of them, the patient received one of the drugs, crosswise. Anxiety control was measured through physical parameters, at the following periods during the surgery: (1) immediately administration of anxiolytic medication, (2) 30 minutes after anxiolytic medication, (3) after extraoral antisepsis, (4) after local anesthesia, (5) during incision, (6) during osteotomy, (7) between osteotomy and odontosection, (8) during odontosection, (9) during surgical store curettage, (10) during suture, and (11) immediately after postoperative care guidelines. Lastly, the volunteers received a self-assessment form in order to report their experience. Statistical analysis was performed using the Wilcoxon test.The final sample was composed of 20 patients, with a mean age of 22.5 years. The results of the physical parameters showed statistically significant differences (P.05) for certain times and physical parameters, especially heart rate (P = .036), which showed the highest control for Passiflora at time point (3). The undesirable effects reported by patients such as drowsiness, muscle relaxation, and dizziness were greater with benzodiazepine.The results of this study suggest that Passiflora may be considered as an alternative to midazolam in controlling anxiety in dentistry. Future studies will focus on other benzodiazepines and herbal medicines.

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures.

Non-syndromic dental agenesis is characterized as the most common developmental anomaly in humans, causing the lack of one or more teeth, in deciduous or permanent dentition. Mutations in specific genes of dental development are pointed as etiological factors of this anomaly. To perform this work, two electronic databases were consulted to conduct a literature survey, including PubMed and BVS. The descriptor "Anodontia" was used in both. The articles were filtered from 2010 to 2020, including full texts, in english, portuguese and spanish. Dissertations, theses and book chapters were discarded. In PubMed, from 508 articles found, 13 were included for review. In the BVS, from 304 articles found, 07 were included for review, totaling 20 articles. Studies have shown that mutations by nucleotide subitusing and deletion were more present in genes that cause dental agenesis (PAX9, MSX1, AXIN2, WNT). In epidemiologic studies, women showed greater involvement than men, both in deciduous and permanent dentition, in a ratio of 3:2. In addition, leukoderms showed greater involvement than melanoderms. Knowledge of the genotype-phenotype correlation between mutations and dental agenesis is important for the dental surgeon, as it assists in diagnosis, genetic counseling, treatment and prognosis. La agenesia dental no sindrómica se caracteriza como la anomalía del desarrollo más común en los seres humanos, causando la falta de uno o más dientes, en la dentición primaria o permanente. Las mutaciones en genes específicos del desarrollo dental se señalan como factores etiológicos de esta anomalía. Para llevar a cabo este trabajo, se consultaron dos bases de datos electrónicas para llevar a cabo una encuesta de literatura, incluyendo PubMed y BVS. El descriptor "Anodontia" se utilizó en ambos. Los artículos se filtraron de 2010 a 2020, incluyendo textos completos, en inglés, portugués y español. Se descartaron disertaciones, tesis y capítulos de libros. En el PubMed de 508 artículos encontrados, 13 fueron incluidos para su revisión. En el BVS de 304 artículos encontrados, 07 fueron incluidos para la revisión, con un total de 20 artículos. Los estudios han demostrado que las mutaciones por nucleótido sulis y la deleción estaban más presentes en los genes causantes de la agenesia (PAX9, MSX1, AXIN2, WNT). En estudios epidemiológicos, las mujeres mostraron una mayor implicación que los hombres, tanto en la dentición primaria y permanente, en una proporción de 3:2. Además, leucodermos mostraron una mayor implicación que melanoderms. El conocimiento de la correlación genotipo-fenotipo entre mutaciones y agenesia dental es importante para el dentista, ya que ayuda en el diagnóstico, asesoramiento genético, tratamiento y pronóstico. A agenesia dentária não sindrômica se caracteriza como a anomalia de desenvolvimento mais comum nos seres humanos, ocasionando a falta de um ou mais dentes, na dentição decídua ou permanente. Mutações em genes específicos do desenvolvimento dentário são apontadas como fatores etiológicos desta anomalia. Para a realização deste trabalho duas bases de dados eletrônicas foram consultadas para fazer um levantamento de literatura, sendo elas: PubMed e BVS. Em ambas utilizou-se o descritor “Anodontia”. Os artigos foram filtrados no período de 2010 a 2020, incluindo textos completos, em idioma inglês, português e espanhol. Descartaram-se dissertações, teses e capítulos de livros. No PubMed, de 508 artigos encontrados, 13 foram incluídos para a revisão. Na BVS, de 304 artigos encontrados, 07 foram incluídos para a revisão, totalizando 20 artigos. Os estudos demonstraram que mutações por substituição de nucleotideo e deleção mostraram-se mais presentes nos genes causadores da agenesia (PAX9, MSX1, AXIN2, WNT). Nos estudos epidemiologicos as mulheres mostraram maior acometimento que os homens, tanto na dentição decidua quanto na permanente, com uma proporção de 3:2. Além disso, os leucodermas apresentaram maior acometimento que os melanodermas. O conhecimento da correlação genótipo-fenótipo entre mutações e agenesia dentária é importante para o cirurgião dentista, pois auxilia no diagnóstico, aconselhamento genético, tratamento e prognóstico.

Objective The aim of this article was to conduct a 25-year retrospective study within an oral surgery department, on the incidence of the ranula in children and its ideal treatment, associated with a literature review on the plunging ranula in pediatrics. Methods A retrospective review of the medical records of pediatric patients (0–12 years) from 1995 to 2020 was performed in an oral surgery department in Maringa/Brazil. The examined data included age of the patients, sex, clinical signs, time of evolution and follow-up, complementary exams, type of ranula, diagnostic hypothesis, surgical procedures and accesses, complications and recurrence. In addition, a literature review was carried out on the plunging ranula in children, using the MEDLINE database, from 1995 to 2020, with the search terms: “PLUNGING RANULA” OR “CERVICAL RANULA. A PICOS was established and PRISMA standards were followed. Results In the retrospective study, of the 11 patients found, 10 were with simple ranulas and only 1 with plunging ranula. All patients were approached by intraoral access, and conservative treatments had higher recurrence rates. The case of plunging ranula was treated by intraoral resection of the sublingual gland and saliva drainage, and obtained good results with 15 years of follow-up. In the literature review, 372 articles were found, which 10 were qualitatively selected after inclusion and exclusion criteria. Excision of the sublingual gland was the most prevalent procedure, and intraoral and extraoral accesses had the same incidence, despite the fact that the last one had higher percentages of complications. Conclusion The treatment of ranulas is variable; however, it is proven that conservative methods have higher rates of recurrence. As for the plunging ranula, resection of the sublingual gland through intraoral access, associated with mucus leakage, is considered a safe and effective treatment.

Osteoradionecrosis (ORN) is one of the most severe oral complications after the head and neck cancer treatment. Tooth extraction, through its traumatic stimulation, is identified as an important predisposing factor. Indications and preventive methods for carrying out these procedures in irradiated patients are questioned, thus, establishing appropriate protocols is essential. This article reports a case of multiple tooth extractions in a cancer patient whose preventive measures were taken without the occurrence of complications. Based on a literature review, this paper accounts the appropriate indications of this procedure, the risk of developing osteoradionecrosis, and the prevention possibilities for this sequela. In addition, this report addresses a viable oral rehabilitation alternative after this kind of surgery by using overdenture on the lower jaw teeth.

Myositis Ossificans Traumatica (MOT) is a rare condition that affects soft tissues after a trauma and hardly affects the mastication muscles. The occurrence in the temporal muscle is uncommon, and trismus is the most prevalent symptom. The diagnosis of the pathology is sufficiently obtained through the collection of clinical history, physical and imaging exams. Differential diagnosis is important mainly to rule out more aggressive diseases, such as osteosarcoma. Treatment becomes more invasive as the ossification matures, and resection of structures adjacent to the tumor, such as coronoidectomy, is well indicated for promoting good results on the mouth opening amplitude. However, to maintain this amplitude, aggressive myofunctional therapy is required. Nevertheless, the literature has no well-defined protocol for this physiotherapy. Therefore, this article reports a rare case of MOT in the temporal muscle that was treated conservatively, with bilateral coronoidectomy and mouth opening physiotherapy, and obtained a satisfactory result. Consequently, it also presents a suggestion of a postoperative physiotherapy protocol.

Comminuted jaw fractures represent a challenge in terms of treatment. The advancement of fixation techniques and materials has contributed to the surgeon providing faster treatment and less complication. Even so, cases that present severe mandibular fragmentation require additional therapies, such as the use of bone grafts and dental implants, in order to recover function, aesthetics and anatomy of the mandible. This work aims to report a case of comminuted mandibular body fracture, which was treated with reconstruction, initially by rigid internal fixation, and secondly, by iliac bone graft and implant-supported oral rehabilitation. Although studies in the literature demonstrate that autogenous grafts show significant resorption, they are still considered the gold standard, and allow an ideal basis for obtaining osseointegration of dental implants. Thus, we concluded that the use of the autogenous bone graft coming from the iliac crest and rehabilitation with implants can be a satisfactory option for functional and aesthetic repair of patients who presented high impact fractures, and developed significant bone defects. Las fracturas conminutas de la mandíbula representan un desafío clínico. El avance de las técnicas y materiales de fijación ha contribuido a que el cirujano proporcione un tratamiento más rápido y menos complicaciones. Aun así, los casos que presentan una severa fragmentación mandibular requieren terapias adicionales, como el uso de injertos óseos e implantes dentales, para recuperar la función, estética y anatomía de la mandíbula. Este estudio tiene como objetivo reportar un caso de fractura conminuta del cuerpo mandibular, que fue tratado con reconstrucción, inicialmente mediante fijación interna rígida y, posteriormente, mediante injerto de cresta ilíaca y rehabilitación oral implantosoportada. Aunque los estudios en la literatura demuestran que los injertos autógenos muestran una reabsorción significativa, todavía se consideran el estándar de oro y permiten una base ideal para obtener la osteointegración de los implantes dentales. Concluimos de esta manera que el uso de injerto óseo autógeno de cresta ilíaca y la rehabilitación con implantes puede ser una opción satisfactoria para la reparación funcional y estética de pacientes que presentaron fracturas de alto impacto y desarrollaron importantes defectos óseos. As fraturas cominutivas da mandíbula representam um desafio clínico. O avanço das técnicas e materiais de fixação tem contribuído para que o cirurgião proporcione um tratamento mais rápido e com menos complicações. Ainda assim, casos que apresentam fragmentação mandibular severa requerem terapias adicionais, como o uso de enxertos ósseos e implantes dentários, a fim de recuperar a função, estética e anatomia da mandíbula. Este trabalho tem como objetivo relatar um caso de fratura cominutiva do corpo mandibular, que foi tratada com reconstrução, inicialmente por fixação interna rígida e, posteriormente, por enxerto de crista ilíaca e reabilitação oral implantossuportada. Embora estudos na literatura demonstrem que enxertos autógenos apresentam reabsorção significativa, eles ainda são considerados padrão-ouro, e permitem uma base ideal para a obtenção da osseointegração de implantes dentários. Concluímos desta forma que a utilização de enxerto ósseo autógeno proveniente da crista ilíaca e a reabilitação com implantes pode ser uma opção satisfatória para a reparação funcional e estética de pacientes que apresentaram fraturas de alto impacto e desenvolveram defeitos ósseos importantes.