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Calcifying odontogenic cyst (COC) is a rare cyst that affects mainly the anterior region of the jaws. Generally, it appears as a unilocular radiolucent lesion containing peripheral foci of calcification, but with radiographic variations depending on the type of presentation. Here, we report an atypical case of COC associated with odontoma, initially diagnosed as a tooth germ, in the posterior region of the mandible of a 10-year-old male patient. Interestingly, the radiographic aspect appeared as a unilocular radiolucent lesion without peripheral foci of calcification in the edentulous region, having its size increased after traction of the impacted tooth adjacent to that area. Thus, the case presented in this study is aimed at calling dentists’ attention to its developmental changes and related pathologies.

Background BRAF p.V600E is reported in up to 80% of ameloblastomas. Despite the high frequency, the presence of this mutation in different histopathological areas of the tumour has not been investigated. This information has an important role in the use of BRAF p.V600E assessment as an auxiliary tool in the differential diagnosis between unicystic ameloblastoma and other odontogenic cystic lesions, especially when only incisional biopsies are available. Therefore, the purpose of the present study was to investigate BRAF p.V600E heterogeneity in unicystic ameloblastoma. Methods Five cases of ameloblastoma and two dentigerous cysts were analysed. The regions exhibiting different microscopic characteristics were selected from each ameloblastoma case and manually dissected. TaqMan allele-specific qPCR or Sanger sequencing was performed to determine BRAF p.V600E status. Results We screened the mutation in a small cohort of UA and no molecular heterogeneity was found. Four cases of ameloblastoma (80%) exhibited BRAF p.V600E in all different areas evaluated. One case did not harbour the mutation in any microscopic region analysed. The BRAF mutation was absent in the dentigerous cysts. Conclusion Ameloblastomas appear to exhibit a homogeneous profile regarding the BRAF p.V600E no matter what histological feature is observed under light microscopy, suggesting that this molecular test may contribute to establish the correct diagnosis in cases microscopically resembling other odontogenic lesions.

Cervical necrotizing fasciitis is a rare polymicrobial infection characterized by extensive, rapidly spreading necrosis of the subcutaneous tissue and superficial fascia. This paper describes a case of necrotizing fasciitis of odontogenic origin in a 55-year-old man who presented with a dental abscess associated with an impacted lower premolar after prolonged use of removable dentures. Treatment included extensive surgical debridement, systemic antibiotics, and intensive care. This case highlights the importance of proper evaluation and diagnosis before the rehabilitation of edentulous patients. A panoramic radiograph can show the presence of an impacted tooth, which must be removed before installation of a removable denture to prevent further complications like that.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico O tratamento do câncer da região de cabeça e pescoço envolve, além da cirurgia, a quimioterapia e a radioterapia. A radioterapia em região de cabeça e pescoço é nociva também para o tecido normal e a cavidade bucal é muito susceptível aos efeitos diretos e indiretos da radiação, que pode afetar o reparo tecidual, especialmente as glândulas salivares e o metabolismo ósseo. Como efeitos adversos podem ocorrer a hipossalivação e xerostomia, disgeusia, infecções orais, cárie dental agressiva, mucosite, trismo e osteoradionecrose. A quimioterapia pode ser associada à radioterapia no tratamento das neoplasias malignas em região de cabeça e pescoço. Tal modalidade terapêutica também pode desencadear alguns efeitos adversos como inflamação intensa na mucosa do sistema digestivo, hipossalivação, dificuldade de deglutição e perda de peso. A possibilidade da investigação de biomarcadores tornou a saliva um importante meio de diagnóstico e monitoramento das doenças por permitir coleta simples e não invasiva, além de fácil manipulação e armazenamento. Este trabalho teve o objetivo de investigar biomarcadores salivares associados à remodelação óssea e reparação tecidual em pacientes irradiados em região de cabeça e pescoço. Trata-se de um estudo transversal. Foram selecionados prospectivamente pacientes submetidos à radioterapia para tratamento de neoplasias de cabeça e pescoço atendidos no Projeto de Extensão “Atendimento de suporte odontológico ao paciente com câncer em região de cabeça e pescoço”, da Faculdade de Odontologia da Universidade Federal de Minas Gerais no período de abril a novembro de 2018. Indivíduos sistemicamente saudáveis nunca expostos à radioterapia compuseram o grupo de comparação, pareado por sexo e idade. Critérios de inclusão e exclusão foram empregados. Saliva total não estimulada foi coletada e processada para dosagem de RANK, RANKL, OPG, EGF, VEGF e MMP-9, pela técnica de ELISA. Análise estatística foi realizada nos programas SPSS® 19.0 e GraphPad Prism® e valores de p < 0,05 foram considerados significantes. O volume salivar foi significativamente menor nos pacientes irradiados. A comparação das dosagens entre os pacientes (n= 29) e os controles não irradiados não revelou diferenças estatisticamente significantes para RANK, OPG e VEGF (p> 0,05). Os valores de EGF (p=0,000) e MMP-9 (p=0,014) foram maiores nos controles que nos pacientes. A dosagem de RANK-L foi maior nos controles, com valor marginal de “p” (0,051). Ao comparar os resultados dos pacientes que receberam apenas RT (n=13) com os indivíduos controle não irradiados, não houve diferença estatisticamente significativa para dosagem de RANK, RANKL, OPG e VEGF (p> 0,05); já EGF (p=0,003) e MMP-9 (p=0,031) apresentaram diferença estatisticamente significante. Ao compararmos pacientes que receberam radioterapia e quimioterapia (n=16) com o controle observa-se diferença estatisticamente significante apenas para dosagem de EGF (p=0,031), que foi maior no controle. Conclui-se que a radiação em região de cabeça e pescoço diminui os níveis salivares de EGF e MMP-9, mas não os de RANK, OPG e VEGF. RANKL também apresenta tendência à diminuição pela radioterapia. A deficiência de EGF e MMP-9 na saliva dos pacientes irradiados em cabeça e pescoço pode estar relacionada ao desenvolvimento dos efeitos deletérios tardios da radiação ionizante na cavidade bucal. Head and neck cancer treatment involves in addition to surgery, chemotherapy and radiotherapy. Radiotherapy in head and neck region is harmful also to the normal tissue and the oral cavity that is very susceptible by the radiation direct and indirect effects, and it can affect tissue repair, notably in the salivary glands and bone metabolism. As consequences may occur hyposalivation and xerostomia, dysgeusia, oral infections, aggressive dental caries, mucositis, trismus and osteoradionecrosis. Chemotherapy may be associated with radiotherapy in the treatment of head and neck malignant neoplasms. This therapeutic modality can also trigger some adverse effects such as intense inflammation of the digestive system mucosa, hyposalivation, difficulty in swallowing and weight loss. Saliva presents a simple sampling and handling, and can be used for the investigation of biomarkers. The aim of this study was to compare salivary biomarkers related to bone remodelling and tissue repair in head and neck irradiated patients and non-irradiated patients. This is a crosssectional prospective study. Patients treated by radiotherapy for head and neck cancer from April to November 2018 were selected. Healthy individuals never exposed to radiotherapy composed the comparison group, paired by sex and age. Exclusion criteria applied. Total unstimulated saliva was collected. RANK, RANKL, OPG, EGF, VEGF e MMP-9 concentration was assessed using ELISA method. Statistics analysis was performed on SPSS® 19.0 e GraphPad Prism®7.0 softwares. Statistical significance was set at p

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.

Purpose The aims of the present study were to discuss the demographic distribution and clinical characteristics of patients with pycnodysostosis (PYCD) and the onset of osteomyelitis and its treatment using a literature review. The authors also report on an update of treatment of mandibular osteomyelitis in a patient with PYCD using a buccal fat pad (BFP) as a free graft. Patients and Methods The study was carried out in 2 steps. In the first step, an electronic search was undertaken in PubMed in March 2018, with 17 articles being included. In the second step, the authors present a case of mandibular osteomyelitis in a 30-year-old woman with PYCD treated by sequestrectomy and a BFP as a free graft (follow-up, 24 months). Results Twenty-one cases of osteomyelitis of the jaws in patients with PYCD were included. Dental extraction, mandibular fracture, and 1 case of facial trauma represented the causes of mandibular osteomyelitis. Treatments included resection associated with antibiotics and sequestrectomy alone or associated with antibiotics. Conclusions Despite the good results of the present case, further studies using the BFP as an adjuvant for jaw osteomyelitis are necessary to elucidate its clinical efficiency and safety.

Lipomas are benign tumors of mature adipocytes unusual in the oral and maxillofacial region. The average size of cheek lipomas in the literature ranges from 1.5 to 2.5 cm, with the maximum size of 5 cm. Their etiology remains unclear. Lipomas present, clinically, as well circumscribed, slow growing, painless masses, usually treated by complete excision. The aim of this paper is to present a 78-year-old Caucasian male patient with a huge cheek lipoma compromising facial esthetics and treated through an intraoral excision. Postoperative period was uneventful with no signs of recurrence. Concluding, the intraoral approach is a relatively simple technique that should be taken into account when considering the surgical removal of cheek lipomas.

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.