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Despite being common pathological entities found in the oral cavity, oral mucoceles can present distinct features, raising several diagnostic possibilities and treatments. In this study, we report the case of a 34-year-old man with an asymptomatic increased volume in the left periorbital region of more than a year, without remission or associated trauma. An aspiration biopsy was performed, followed by an excisional biopsy, and the specimen was sent for histopathological examination. Results led to the diagnosis of an oral mucocele. Surgical removal was performed in an excisional biopsy. Subsequently, the patient recovered promptly without further complications. Although oral mucoceles recur relatively often, its prognosis is good. This case emphasizes the importance of obtaining a detailed disease history, knowledge of its clinical features, and etiopathogenesis combined with complementary examinations to establish diagnostic hypotheses and converge on an adequate and individualized treatment plan RESUMO Apesar de serem entidades patológicas comumente encontradas na cavidade oral, as mucoceles podem apresentar características distintas, o que pode sugerir diversas possibilidades diagnósticas e de tratamento. Paciente do gênero masculino, 34 anos, compareceu ao ambulatório com queixa de aumento de volume assintomático na região periorbitária esquerda há mais de um ano, sem remissão ou trauma associado. Foi realizada biópsia aspirativa seguida de biópsia excisional e a amostra encaminhada para exame histopatológico, que confirmou o diagnóstico de mucocele oral. O paciente evoluiu sem queixas e sem recidiva. Apesar da alta taxa de recorrência, mucoceles orais têm um bom prognóstico. Este relato de caso enfatiza a importância da obtenção de uma história detalhada da doença, do conhecimento de suas características clínicas e da etiopatogenia, para estabelecer hipóteses diagnósticas e convergir para um plano de tratamento adequado e individualizado.

A osteonecrose maxilar associada a medicamentos (OMAM) é uma doença relativamente rara com alta morbidade. Nesse estudo, relatamos o tratamento de dois casos recalcitrantes de OMAM nas mandíbulas de duas idosas cujo tratamento para osteoporose foi feito com alendronato. Ambas as pacientes receberam sequestrectomia combinada com terapia fotodinâmica antimicrobiana (TFA) e fotobiomodulação (FBM). Durante o perioperatório e em atendimentos semanais pós-operatórios TFA tratou três pontos anatômicos através de um laser de diodo emitindo uma onda contínua de arseneto de gálio-alumínio a 660 nm (laser vermelho), 0,028 cm2, 0,1 W, 3,57 W/cm2 por 90 s por ponto, 9 J por ponto, 321 J/cm2 e uma energia total de 27 J. O tratamento com FBM foi aplicado em sessões pós-operatórias semanais, consistindo em ondas com 808 nm de comprimento e os demais parâmetros idênticos. Ambas as pacientes foram acompanhadas por dois anos e não relataram a recorrência de OMAM. Logo, TFA e FBM podem ser consideradas terapias adjuvantes não-invasivas para OMAM sem efeitos adversos. Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare condition with high morbidity. In this study, we report the management of two recalcitrant cases of MRONJ in the mandibles of two older women who received treatment with alendronate for osteoporosis. Sequestrectomies, combined with antimicrobial photodynamic therapy (aPDT) and photobiomodulation (PBMT), were performed in both patients. During perioperative and weekly postoperative aPDT sessions, a diode laser treated three anatomical points by emitting a continuous gallium-aluminum-arsenide wave at 660 nm (red laser), 0.028 cm2, 0.1 W, 3.57 W/cm2 for 90 s per point, 9 J per point, 321 J/cm2, and a total energy of 27 J. PBMT was applied weekly after surgery at 808 nm wavelength (other parameters being equal) for wound healing and pain relief. Both patients were followed-up for two years without any report of recurrence. Thus, aPDT and PBMT can be considered non-invasive adjuvant therapies for MRONJ without any adverse effects.

Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

O objetivo deste estudo é avaliar o efeito da terapia de fotobiomodulação (TFBM) na viabilidade de osteoblastos e cultura de fibroblastos em diferentes concentrações de alendronato ou ácido zoledrônico. Duas linhagens celulares – células de camundongos semelhantes a osteoblastos (OSTEO 1) e fibroblastos de mucosa bucal humana (FMM1) – foram utilizadas. As células foram submetidas a diferentes concentrações de bisfosfonatos (1 μM, 10 μM e 100 μM de alendronato de sódio e 3 μM, 5 μM e 10 μM de ácido zoledrônico) por 24 horas. Em seguida, as culturas receberam TFBM. As irradiações foram aplicadas com laser de diodo (InGaAIP, 660 nm, 30 mW, spot 0,028 cm2) em modo contínuo, pontual e de contato, em duas densidades de energia: 5 J/cm2 (4,5 s) ou 10 J/cm2 (9s) com intervalos de 6 horas. A viabilidade celular foi determinada pelo ensaio de atividade mitocondrial (MTT) 24 h após a última irradiação. Os dados foram comparados pelo ANOVA One-Way, complementado pelo teste de Tukey (p < 0,05). O alendronato de sódio nas concentrações de 100 μM e 10 μM e o ácido zoledrônico na concentração de 10 μM apresentaram maior toxicidade a longo prazo. A viabilidade celular do grupo tratado com TFBM foi significativamente maior que a do grupo de controle negativo. O mesmo ocorreu com os osteoblastos tratados com as maiores concentrações do fármaco (5 e 10 μM), apesar de não atingir a viabilidade celular do grupo de controle positivo, apresentou maior viabilidade do que o controle negativo no qual as células não foram irradiadas. Nos grupos submetidos ao ácido zoledrônico, controles positivos apresentaram maior viabilidade celular. Concluímos que sob os parâmetros aplicados neste estudo, a TFBM, com uma densidade de energia de 5 J/cm2, foi capaz de reverter a toxicidade do alendronato sódico aplicado nas concentrações mais altas em ambos os tipos celulares, enquanto a toxicidade do ácido zoledrônico, independentemente de suas concentrações, foi não influenciada pela TFBM. The goal of this study is to evaluate the effect of photobiomodulation therapy (PBMT) on the viability of osteoblasts and cultured fibroblasts in different concentrations of alendronate or zoledronic acid. Two cell lines: osteoblast-like mouse cells (OSTEO 1) and human buccal mucosa fibroblast (FMM1) were used. Cells were submitted to different concentrations of bisphosphonates (1 μM, 10 μM, and 100 μM sodium alendronate and 3 μM, 5 μM and 10 μM zoledronic acid) for 24 hours. Next, the cultures received PBMT. The irradiations were applied with a diode laser (InGaAIP, 660 nm, 30 mW, spot 0.028 cm2) in continuous, punctual and contact mode at two energy densities: 5 J/cm2 (4.5 s) or 10 Jcm2 (9s) with 6 hours-intervals. Cell viability was determined by mitochondrial activity assay (MTT) 24 h after the last irradiation. The data were compared by the one way- ANOVA, complemented by the Tukey’s test (p < 0.05). Sodium alendronate at concentrations of 100 μM and 10 μM and zoledronic acid at 10 μM concentration showed higher long-term toxicity. The cellular viability of the PBMT treated group was significantly higher than that of the negative control group. The same occurred with the osteoblasts treated with the highest concentrations of the drug (5 and 10 μM), despite not reaching the cell viability of the positive control group, it presented greater viability than the negative control where the cells were not irradiated. In the groups submitted to zoledronic acid, positive controls presented greater cell viability. We concluded that under the parameters applied in this study, PBMT at an energy density of 5 J/cm2 was able to revert the toxicity of sodium alendronate applied at the higher concentrations in both cell types, whereas zoledronic acid toxicity, regardless of its concentrations, was not influenced by PBMT.

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.