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SURGICAL TREATMENT ASSOCIATED WITH LIQUID NITROGEN CRYOTHERAPY IN ODONTOGENIC MYXOMA IN THE MANDIBLE: A CASE REPORT
ABSTRACTS
e46
before, during, and after cancer treatment. A male African American patient, 52 years of age with a history of being a former smoker and alcoholic for 12 years, was diagnosed in 2005 with an oral squamous cell carcinoma in the left lateral lingual surface, clinical stage of T2 N0 M0, and treated with head and neck surgery with negative cervical lymph nodes. After 12 years, a routine examination showed an extensive exophytic ulcer on the hard palate spreading to the soft palate. An incisional biopsy was performed whose diagnosis indicated Merkel cell carcinoma, confirmed by immunohistochemical study. He was treated successfully with chemotherapy (cisplatin and etoposide). This report seeks to show how important is to stimulate dental surgeons to perform routine intraoral examinations.
PREVENTION PROTOCOL OF OSTEORADIONECROSIS AFTER RADIOTHERAPY OF THE HEAD AND NECK: BIMODAL TREATMENT. FERNANDO SILVA DE CASTRO, HELENO OLIVEIRA DE MORAIS, ROSEMIRO MENEZES MACIEL, SARAH APARECIDA FERREIRA ANTERO, WAGNER PINTO DAS CHAGAS, CARLA RENATA PETILLO and, ^ e ISRAEL MONICA SIMOES Although osteoradionecrosis is considered a late sequela of radiotherapy in the head and neck region, it is the most severe. Dental examination should be performed in advance to eliminate all odontogenic foci, decreasing the chance of developing osteoradionecrosis. A white female patient, 50 years of age, was treated with adjuvant radiotherapy for undetected primary tumor with cervical metastasis. After 6 months, extensive caries in the lower left second molar were noticed, which were removed and a glass ionomer restoration and indirect pulp-capping with calcium hydroxide were performed. Dental pulp vitality test along with periapical radiography to follow the treatment’s progress were also done. After 10 months, a periapical radiolucent lesion was observed. Pulp vitality testing turned out negative. As a sequela of radiotherapy, the patient presented with severe trismus, making endodontic treatment impossible. Exodontic procedure with antibiotic and laser therapy for the prevention of osteoradionecrosis was recommended, and the patient remains without any complications.
MANDIBULAR OSTEONECROSIS AFTER 40 YEARS OF ORAL ALENDRONATE: CASE REPORT. JULIA VIANNA NERI ANDRADE REIS, CAMILLA PALMEIRA ESTEVES, LIVIA ANDRADE ^ DA E SILVA, IEDA VITORIA, VIRGINIA DIAS UZE MARGARIDA CRUSOE ROCHA REBELLO, ANDRE CARLOS DE FREITAS and, LUCIANA MARIA PEDREIRA RAMALHO One of the adverse effects of the use of bisphosphonates is osteonecrosis of the jaw. The present study aims to report a clinical case of an 89-year-old female patient, who had used alendronate for more than 40 years, and was diagnosed with symptomatic osteonecrosis in the mandible after dental implants rehabilitation. In 2017 on clinical examination, hyperemia and persistent infection were observed. Radiographically, extensive bone involvement was found in the mandibular body, although clinical bone exposure did not reveal the complexity of the case. The proposed treatment was the association between pentoxifylline and tocopherol, laser, and conservative surgical approach. Currently, the patient has been asymptomatic for 4 months. Although the presence of
OOOO January 2020 osteonecrosis by the use of oral bisphosphonates is not common, the dental surgeon must be aware of this condition so the professional can diagnose and conduct the treatment in order to improve the quality of life of the patient.
PARACOCCIDIOIDOMYCOSIS IN A FEMALE e PATIENT—A CASE REPORT. BRUNA SIMOES DE RESENDE, BIANCA MATTOS DOS SANTOS GUERRA, NATHALIA DE ALMEIDA FREIRE, WAGNER CHAGAS, BRUNO AUGUSTO BENEVENUTO e ^ DE ANDRADE, MARIO ROMANACH and, MONICA e ISRAEL SIMOES Paracoccidioidomycosis is a systemic disease caused by the dimorphic fungus Paracoccidioides brasiliensis and is most common in Latin America. It has a marked predilection for men. A 76-year-old woman looked for help complaining about "a mouth ulcer, which extended all the way from the tongue to the throat." The patient reported that the lesions had been hurting for 3 months. She also affirmed being a smoker for 30 years. In the extraoral physical exam, a cervical bilateral, sublingual, and submandibular lymphadenopathy was noted. In the intraoral exam ulcerated lesions on the dorsum and apex of the tongue were observed, as well as a nodule in the right pterygomandibular raphe. The diagnostic hypotheses were squamous cell carcinoma and paracoccidioidomycosis. An incisional biopsy was performed and a conclusion of paracoccidioidomycosis diagnostic was reached. The patient underwent treatment under the surveillance of an infectious diseases specialist and has been using systemic antifungal medication since then.
ORAL MANIFESTATIONS OF MUCOCUTANEOUS LEISHMANIASIS: A 4-CASE SERIES. ^ LIVIA SAMARA FRANCIELLE DE SOUZA PINTO, ALINE FERNANDA CRUZ, JULIO CESAR TANOS DE LACERDA, TARCILIA SILVA, FELIPE PAIVA FONSECA, MARIA CASSIA FERREIRA AGUIAR and, RENATA GONCALVES ¸ RESENDE Mucosal leishmaniosis (ML) is a chronic infection that affects the upper respiratory tract or oral mucosa, caused by Leishmania protozoan parasites. Four male patients between the ages of 60 and 94 years presented with oral lesions of ML. All of them presented with destruction of the nasal septum and infiltrative lesions in the soft palate, with a granulomatous and erythematous base. One of the patients presented with edema and erythema in the nose and middle face. The histopathologic exam was performed in all the cases, but, polymerase chain reaction (PCR) was necessary in 2 cases to confirm the diagnosis. The older patient received treatment with liposomal amphotericin B but then died due to generalized infection. The other 3 patients were treated with meglumine antimoniate. In 2 cases, the lesions healed and we have no data regarding to third patient. One patient died due to complications of the treatment. Support: FAPEMIG
SURGICAL TREATMENT ASSOCIATED WITH LIQUID NITROGEN CRYOTHERAPY IN ODONTOGENIC MYXOMA IN THE MANDIBLE: A CASE REPORT. JULIANA SANTOS DE JESUS AZEVEDO, JULIA VIANNA NERI ANDRADE REIS, JULIANA BORGES DE LIMA DANTAS, SILVIA REGINA ^ DE ALMEIDA REIS, ANTONIO MARCIO TEIXEIRA
OOOO Volume 129, Number 1 MARCHIONNI, MIGUEL GUSTAVO SETUBAL ^ ANDRADE and, ANTONIO LUCINDO PINTO DE CAMPOS SOBRINHO The odontogenic myxoma is a benign odontogenic tumor, with aggressive characteristics, capable of causing many sequelae with a consequent decrease in a patient’s quality of life. The present study aims to report a clinical case of odontogenic myxoma treated by radical surgery in association with liquid nitrogen cryotherapy. A 37-year-old female patient sought dental care with complaints of increased jaw volume but was otherwise asymptomatic. Clinical examination revealed increasing in volume in the vestibular-lingual region of the mandibular symphysis. Radiographically, an extensive multilocular radiolucent area was observed. The proposed treatment was the surgical approach of marginal block resection, with preservation of the mandibular base for bow maintenance, associated with the freezing of the region in order to minimize the risks of recurrence, due to the lack of capsule and lesion’s loose consistency. The patient is under a 1-year nonsymptomatic follow-up, without recurrence and rehabilitation with a partial, removable denture.
CONSERVATIVE MANAGEMENT OF A MULTICYSTIC LESION OF THE ANTERIOR MANDIBLE: HISTOLOPATHOLOGIC ASPECTS CHANGE THE DIAGNOSIS. LOHANNA KAROLINE RODRIGUES ROSSETE, JUAN PABLO DA SILVA BARBOSA, LINDEMBERG BENTES DA SILVA, LARISSA HELENA DE OLIVEIRA RESENDE, LUCAS SILVA DAS NEVES and, TIAGO NOVAES PINHEIRO The present study aims to report a case of a cystic lesion affecting the left paramental edentulous mandible region in a 62-year-old female patient. The patient reported a 1-year growth history, and noted pain in the area during the last few months. Clinical inspection showed a multilobulated, translucent swelling with a well-defined cystic radiolucency aspect on imaging examination. Presurgical puncture of the lesion revealed a transparent liquid content. A cystic decompression was then performed and the obtained specimen from the roof of the lesion was submitted for histopathologic examination. The results indicated that the lesion was compatible with botryoid cyst. After 5 months, an enucleation of the lesion was performed. Surprisingly a new pathologic report changed the diagnosis to multicystic ameloblastoma. We discuss the microscopic characteristics and the changes observed on the product of enucleation, as well as its clinical implications.
ODONTOGENIC MYXOMA. CONSTANZA ULLOA BEQUER, MACARENA SHERMAN ALLENDORF, JUAN PABLO BRITO SANCHEZ, MAURICIO CARRASCO RODRIGUEZ, JUAN CARLOS PASTOR MORALES, ANA MARIA SALAZAR ROA and, PAULINA CUBILLOS GONZALEZ A 19-year-old female patient was referred to the oral medicine clinic to evaluate an asymptomatic and unilateral swelling in the left mandibular area. The periapical radiography showed an apparently unilocular radiolucency located in the radicular area of the left second premolar. Previous radiographic examinations and a cone beam CT study were requested for lesion study. An incisional biopsy was performed for histopathologic analysis. Macroscopic examination showed a sample with a white and
ABSTRACTS
e47
gelatinous appearance. Microscopically, the lesion was composed of haphazardly arranged stellate, spindle-shaped, and round cells in an abundant, loose myxoid stroma. Histopathologicfindings were compatible with odontogenic myxoma. Immunohistochemical study was performed to rule out other pathologic entities. The complete elimination of the lesion was performed by block resection followed by reconstruction and subsequent clinical controls. The case is reported under the informed consent of the patient.
NASOPALATINE DUCT CYST IN AN ELDERLY EDENTULOUS PATIENT. LETICIA BEATRIZ DA CRUZ SANTOS, BEATRIZ BEZERRA RIBEIRO, GIOVANNA DE ALCANTARA SANTOS, LIONEY NOBRE CABRAL and, TIAGO NOVAES PINHEIRO Nasopalatine duct cyst in edentulous areas may be associated with local pain, presence of mucosal patency of the duct, and even secondary infection. The present study aims to report the case of a 52-year-old black female patient who attended the dental institution complaining of pain in the anterior palate area. The patient reported a history of previous procedure to puncture and remove fluid from the anterior maxilla, in the past 6 years, as an urgency procedure but evaded treatment due to partial remission of the symptoms at that time. In the intraoral clinical examination, there was no presence of color alteration as well as swelling in the anterior palate area. The tomographic examination suggested a nasopalatine duct cyst. An excisional biopsy was performed and the material was referred for histopathologic analysis, confirming the diagnosis. After 6 months of follow-up, the patient was released with no further complications.
MULTIPLE APPROACH OF A LARGE CYSTIC LESION IN THE ANTERIOR MAXILLA: PEARLS AND PITFALLS. LETICIA BEATRIZ DA ^ CRUZ SANTOS, BETHANIA CAMARGO PINHEIRO, DANIEL FROTA DE SOUZA, PAMELA OLIVEIRA SANTOS, PAULA GOMES SOARES and, TIAGO NOVAES PINHEIRO We report the challenges faced in the treatment of a large cystic lesion in the anterior maxilla. A 32-year-old woman presented herself to the urgency service, complaining about discomfort in the region of nonvital tooth #22. Endodontic treatment was started and the patient reported to the oral medicine discipline of the authors’ institution. Imaging and clinical examination revealed a large cystic lesion involving the hard palate, nasal cavity, and the anterior portion of the maxillary sinus. A cystic decompression was performed along with an incisional biopsy that led to a histopathologic diagnosis of periapical cyst. A second surgical approach tried to enucleate the lesion but the ostium of decompression remained open, thereby impairing bone formation. A third approach was performed along with allogeneic particulate bone graft and reabsorbable membrane barrier positioning. Radiographic follow-up showed the graft integration and good recovery of the lesion after 4 months of follow-up care.
PAPILLARY SQUAMOUS CELL CARCINOMA: A CASE REPORT. TARSILA DE CARVALHO FREITAS RAMOS, LISIA DALTRO
e46
before, during, and after cancer treatment. A male African American patient, 52 years of age with a history of being a former smoker and alcoholic for 12 years, was diagnosed in 2005 with an oral squamous cell carcinoma in the left lateral lingual surface, clinical stage of T2 N0 M0, and treated with head and neck surgery with negative cervical lymph nodes. After 12 years, a routine examination showed an extensive exophytic ulcer on the hard palate spreading to the soft palate. An incisional biopsy was performed whose diagnosis indicated Merkel cell carcinoma, confirmed by immunohistochemical study. He was treated successfully with chemotherapy (cisplatin and etoposide). This report seeks to show how important is to stimulate dental surgeons to perform routine intraoral examinations.
PREVENTION PROTOCOL OF OSTEORADIONECROSIS AFTER RADIOTHERAPY OF THE HEAD AND NECK: BIMODAL TREATMENT. FERNANDO SILVA DE CASTRO, HELENO OLIVEIRA DE MORAIS, ROSEMIRO MENEZES MACIEL, SARAH APARECIDA FERREIRA ANTERO, WAGNER PINTO DAS CHAGAS, CARLA RENATA PETILLO and, ^ e ISRAEL MONICA SIMOES Although osteoradionecrosis is considered a late sequela of radiotherapy in the head and neck region, it is the most severe. Dental examination should be performed in advance to eliminate all odontogenic foci, decreasing the chance of developing osteoradionecrosis. A white female patient, 50 years of age, was treated with adjuvant radiotherapy for undetected primary tumor with cervical metastasis. After 6 months, extensive caries in the lower left second molar were noticed, which were removed and a glass ionomer restoration and indirect pulp-capping with calcium hydroxide were performed. Dental pulp vitality test along with periapical radiography to follow the treatment’s progress were also done. After 10 months, a periapical radiolucent lesion was observed. Pulp vitality testing turned out negative. As a sequela of radiotherapy, the patient presented with severe trismus, making endodontic treatment impossible. Exodontic procedure with antibiotic and laser therapy for the prevention of osteoradionecrosis was recommended, and the patient remains without any complications.
MANDIBULAR OSTEONECROSIS AFTER 40 YEARS OF ORAL ALENDRONATE: CASE REPORT. JULIA VIANNA NERI ANDRADE REIS, CAMILLA PALMEIRA ESTEVES, LIVIA ANDRADE ^ DA E SILVA, IEDA VITORIA, VIRGINIA DIAS UZE MARGARIDA CRUSOE ROCHA REBELLO, ANDRE CARLOS DE FREITAS and, LUCIANA MARIA PEDREIRA RAMALHO One of the adverse effects of the use of bisphosphonates is osteonecrosis of the jaw. The present study aims to report a clinical case of an 89-year-old female patient, who had used alendronate for more than 40 years, and was diagnosed with symptomatic osteonecrosis in the mandible after dental implants rehabilitation. In 2017 on clinical examination, hyperemia and persistent infection were observed. Radiographically, extensive bone involvement was found in the mandibular body, although clinical bone exposure did not reveal the complexity of the case. The proposed treatment was the association between pentoxifylline and tocopherol, laser, and conservative surgical approach. Currently, the patient has been asymptomatic for 4 months. Although the presence of
OOOO January 2020 osteonecrosis by the use of oral bisphosphonates is not common, the dental surgeon must be aware of this condition so the professional can diagnose and conduct the treatment in order to improve the quality of life of the patient.
PARACOCCIDIOIDOMYCOSIS IN A FEMALE e PATIENT—A CASE REPORT. BRUNA SIMOES DE RESENDE, BIANCA MATTOS DOS SANTOS GUERRA, NATHALIA DE ALMEIDA FREIRE, WAGNER CHAGAS, BRUNO AUGUSTO BENEVENUTO e ^ DE ANDRADE, MARIO ROMANACH and, MONICA e ISRAEL SIMOES Paracoccidioidomycosis is a systemic disease caused by the dimorphic fungus Paracoccidioides brasiliensis and is most common in Latin America. It has a marked predilection for men. A 76-year-old woman looked for help complaining about "a mouth ulcer, which extended all the way from the tongue to the throat." The patient reported that the lesions had been hurting for 3 months. She also affirmed being a smoker for 30 years. In the extraoral physical exam, a cervical bilateral, sublingual, and submandibular lymphadenopathy was noted. In the intraoral exam ulcerated lesions on the dorsum and apex of the tongue were observed, as well as a nodule in the right pterygomandibular raphe. The diagnostic hypotheses were squamous cell carcinoma and paracoccidioidomycosis. An incisional biopsy was performed and a conclusion of paracoccidioidomycosis diagnostic was reached. The patient underwent treatment under the surveillance of an infectious diseases specialist and has been using systemic antifungal medication since then.
ORAL MANIFESTATIONS OF MUCOCUTANEOUS LEISHMANIASIS: A 4-CASE SERIES. ^ LIVIA SAMARA FRANCIELLE DE SOUZA PINTO, ALINE FERNANDA CRUZ, JULIO CESAR TANOS DE LACERDA, TARCILIA SILVA, FELIPE PAIVA FONSECA, MARIA CASSIA FERREIRA AGUIAR and, RENATA GONCALVES ¸ RESENDE Mucosal leishmaniosis (ML) is a chronic infection that affects the upper respiratory tract or oral mucosa, caused by Leishmania protozoan parasites. Four male patients between the ages of 60 and 94 years presented with oral lesions of ML. All of them presented with destruction of the nasal septum and infiltrative lesions in the soft palate, with a granulomatous and erythematous base. One of the patients presented with edema and erythema in the nose and middle face. The histopathologic exam was performed in all the cases, but, polymerase chain reaction (PCR) was necessary in 2 cases to confirm the diagnosis. The older patient received treatment with liposomal amphotericin B but then died due to generalized infection. The other 3 patients were treated with meglumine antimoniate. In 2 cases, the lesions healed and we have no data regarding to third patient. One patient died due to complications of the treatment. Support: FAPEMIG
SURGICAL TREATMENT ASSOCIATED WITH LIQUID NITROGEN CRYOTHERAPY IN ODONTOGENIC MYXOMA IN THE MANDIBLE: A CASE REPORT. JULIANA SANTOS DE JESUS AZEVEDO, JULIA VIANNA NERI ANDRADE REIS, JULIANA BORGES DE LIMA DANTAS, SILVIA REGINA ^ DE ALMEIDA REIS, ANTONIO MARCIO TEIXEIRA
OOOO Volume 129, Number 1 MARCHIONNI, MIGUEL GUSTAVO SETUBAL ^ ANDRADE and, ANTONIO LUCINDO PINTO DE CAMPOS SOBRINHO The odontogenic myxoma is a benign odontogenic tumor, with aggressive characteristics, capable of causing many sequelae with a consequent decrease in a patient’s quality of life. The present study aims to report a clinical case of odontogenic myxoma treated by radical surgery in association with liquid nitrogen cryotherapy. A 37-year-old female patient sought dental care with complaints of increased jaw volume but was otherwise asymptomatic. Clinical examination revealed increasing in volume in the vestibular-lingual region of the mandibular symphysis. Radiographically, an extensive multilocular radiolucent area was observed. The proposed treatment was the surgical approach of marginal block resection, with preservation of the mandibular base for bow maintenance, associated with the freezing of the region in order to minimize the risks of recurrence, due to the lack of capsule and lesion’s loose consistency. The patient is under a 1-year nonsymptomatic follow-up, without recurrence and rehabilitation with a partial, removable denture.
CONSERVATIVE MANAGEMENT OF A MULTICYSTIC LESION OF THE ANTERIOR MANDIBLE: HISTOLOPATHOLOGIC ASPECTS CHANGE THE DIAGNOSIS. LOHANNA KAROLINE RODRIGUES ROSSETE, JUAN PABLO DA SILVA BARBOSA, LINDEMBERG BENTES DA SILVA, LARISSA HELENA DE OLIVEIRA RESENDE, LUCAS SILVA DAS NEVES and, TIAGO NOVAES PINHEIRO The present study aims to report a case of a cystic lesion affecting the left paramental edentulous mandible region in a 62-year-old female patient. The patient reported a 1-year growth history, and noted pain in the area during the last few months. Clinical inspection showed a multilobulated, translucent swelling with a well-defined cystic radiolucency aspect on imaging examination. Presurgical puncture of the lesion revealed a transparent liquid content. A cystic decompression was then performed and the obtained specimen from the roof of the lesion was submitted for histopathologic examination. The results indicated that the lesion was compatible with botryoid cyst. After 5 months, an enucleation of the lesion was performed. Surprisingly a new pathologic report changed the diagnosis to multicystic ameloblastoma. We discuss the microscopic characteristics and the changes observed on the product of enucleation, as well as its clinical implications.
ODONTOGENIC MYXOMA. CONSTANZA ULLOA BEQUER, MACARENA SHERMAN ALLENDORF, JUAN PABLO BRITO SANCHEZ, MAURICIO CARRASCO RODRIGUEZ, JUAN CARLOS PASTOR MORALES, ANA MARIA SALAZAR ROA and, PAULINA CUBILLOS GONZALEZ A 19-year-old female patient was referred to the oral medicine clinic to evaluate an asymptomatic and unilateral swelling in the left mandibular area. The periapical radiography showed an apparently unilocular radiolucency located in the radicular area of the left second premolar. Previous radiographic examinations and a cone beam CT study were requested for lesion study. An incisional biopsy was performed for histopathologic analysis. Macroscopic examination showed a sample with a white and
ABSTRACTS
e47
gelatinous appearance. Microscopically, the lesion was composed of haphazardly arranged stellate, spindle-shaped, and round cells in an abundant, loose myxoid stroma. Histopathologicfindings were compatible with odontogenic myxoma. Immunohistochemical study was performed to rule out other pathologic entities. The complete elimination of the lesion was performed by block resection followed by reconstruction and subsequent clinical controls. The case is reported under the informed consent of the patient.
NASOPALATINE DUCT CYST IN AN ELDERLY EDENTULOUS PATIENT. LETICIA BEATRIZ DA CRUZ SANTOS, BEATRIZ BEZERRA RIBEIRO, GIOVANNA DE ALCANTARA SANTOS, LIONEY NOBRE CABRAL and, TIAGO NOVAES PINHEIRO Nasopalatine duct cyst in edentulous areas may be associated with local pain, presence of mucosal patency of the duct, and even secondary infection. The present study aims to report the case of a 52-year-old black female patient who attended the dental institution complaining of pain in the anterior palate area. The patient reported a history of previous procedure to puncture and remove fluid from the anterior maxilla, in the past 6 years, as an urgency procedure but evaded treatment due to partial remission of the symptoms at that time. In the intraoral clinical examination, there was no presence of color alteration as well as swelling in the anterior palate area. The tomographic examination suggested a nasopalatine duct cyst. An excisional biopsy was performed and the material was referred for histopathologic analysis, confirming the diagnosis. After 6 months of follow-up, the patient was released with no further complications.
MULTIPLE APPROACH OF A LARGE CYSTIC LESION IN THE ANTERIOR MAXILLA: PEARLS AND PITFALLS. LETICIA BEATRIZ DA ^ CRUZ SANTOS, BETHANIA CAMARGO PINHEIRO, DANIEL FROTA DE SOUZA, PAMELA OLIVEIRA SANTOS, PAULA GOMES SOARES and, TIAGO NOVAES PINHEIRO We report the challenges faced in the treatment of a large cystic lesion in the anterior maxilla. A 32-year-old woman presented herself to the urgency service, complaining about discomfort in the region of nonvital tooth #22. Endodontic treatment was started and the patient reported to the oral medicine discipline of the authors’ institution. Imaging and clinical examination revealed a large cystic lesion involving the hard palate, nasal cavity, and the anterior portion of the maxillary sinus. A cystic decompression was performed along with an incisional biopsy that led to a histopathologic diagnosis of periapical cyst. A second surgical approach tried to enucleate the lesion but the ostium of decompression remained open, thereby impairing bone formation. A third approach was performed along with allogeneic particulate bone graft and reabsorbable membrane barrier positioning. Radiographic follow-up showed the graft integration and good recovery of the lesion after 4 months of follow-up care.
PAPILLARY SQUAMOUS CELL CARCINOMA: A CASE REPORT. TARSILA DE CARVALHO FREITAS RAMOS, LISIA DALTRO