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To report a case of non-neural granular cell tumor (NN-GCT), an uncommon neoplasm, with only six studies worldwide describing cases involving the oral cavity. Methods: A 26-year-old male patient with an erythematous, firm, polypoid nodule in the floor of the mouth that exhibited areas of ulceration and mild bleeding to the touch. A biopsy was performed to aid in the diagnosis. Results: Based on the histopathological and immunohistochemical results (vimentin +, CD68 +, S100 -), the diagnosis was compatible with S100-negative (primitive polypoid non-neural) granular cell tumor. No recurrence was observed over two years of follow-up. Conclusion: The diagnosis of NN-GCT is extremely challenging because this tumor shares histological and immunophenotypic features with many benign and malignant tumors. Although oral NN-GCT may exhibit unusual and atypical histological features, it has an indolent behavior. Thus, until more cases of oral involvement are reported, complete resection and close follow-up are recommended

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We aimed to determine the prevalence of anxiety and to identify associated factors among multi-professional residents in Brazil during the early days of the COVID-19 pandemic. A cross-sectional study included a sample of 752 multi-professional residents selected by snowball technique. Symptoms of anxiety were measured by the Beck anxiety inventory scale (≥ 16 cut-off). We used WHOQOL-BREF to access the health-related quality of life and the Maslach Burnout Inventory to measure the burnout syndrome. PR and respective 95% confidence intervals (CI) were calculated using the Poisson regression model. The prevalence of anxiety was 41.2% (310/752). Some variables were strongly associated with anxiety: afraid of getting COVID-19; extra work demand during COVID-19 pandemic; sweating/wheezing/increased heart rate during work; feeling safe when using personal protective equipment at work, and psychological support from residence preceptors. Residents with symptoms of anxiety showed high emotional exhaustion at work (36.6 ± 9.6 vs. 24.7 ± 10.7, P = 0.001) and depersonalization (8.9 ± 6.0 vs. 5.6 ± 4.9, P = 0.001). Correlations coefficients between emotional exhaustion versus Physical WHOQOL-BREF and between emotional exhaustion versus Psychological WHOQOL-BREF were significantly lower among residents without anxiety (P = 0.027 and P = 0,03, respectively). The prevalence of anxiety was high and strongly associated with several variables, particularly with being afraid of getting COVID-19, the perception of workload, somatization (sweating, wheezing and increased heart rate during work), feeling unsafe when using personal protective equipment, and lack of psychological support from residence preceptors. Anxiety was associated with increased emotional exhaustion and depersonalization and low health-related quality of life during the COVID-19 pandemic in Brazil. Low WHOQOL-BREF environment domain, and high emotional exhaustion MBI domain increased the chances of presenting symptoms of anxiety.

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Introdução: A osteotomia vertical anterior de mandíbula é um procedimento de extrema versatilidade, podendo ser empregado em casos selecionados nos quais a mecânica ortodôntica tem suas limitações. Em contrapartida, existem estudos que demonstram que as complicações deste procedimento incluem a pseudoartrose, neuropraxia, a possibilidade de problemas periodontais e o fato de que esta técnica nem sempre é útil. Relato de Caso: O objetivo deste trabalho é relatar o caso de uma paciente submetida a cirurgia de osteotomia vertical anterior de mandíbula no ano de 2002, evoluindo sem integração óssea e com mobilidade mandibular durante anos, apresentando como queixa principal, a retração gengival. Sendo proposta no ano de 2018, uma reabordagem cirúrgica, com o uso de enxerto da crista ilíaca e placa de reconstrução. Considerações Finais: Conclui-se que o uso de enxerto ósseo autogéno, associado à redução e fixação com placas de reconstrução, são considerados positivos para o tratamento de pseudoartroses, podendo ser considerados como opção durante o tratamento cirúrgico... (AU)

Introduction: The anterior vertical osteotomy of the mandible is an extremely versatile procedure and can be used in selected cases in which orthodontic mechanics have their limitations. On the other hand, there are studies that demonstrate that the complications of this procedure include pseudoarthrosis, neuropraxia, the possibility of periodontal problems and the fact that this technique is not always useful. Case Report: The objective of this study is to report the case of a patient who underwent surgery for anterior vertical osteotomy of the mandible in 2002, evolving without bone integration and with mandibular mobility for years, presenting as the main complaint, gingival retraction. Being proposed in 2018, a surgical re-approach, with the use of iliac crest graft and reconstruction plate. Final Considerations: It is concluded that the use of autogenous bone graft, associated with reduction and fixation with reconstruction plates, are considered positive for the treatment of pseudoarthrosis, and can be considered as an option during surgical treatment... (AU)

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Diversas anomalias craniofaciais acometem os seres humanos, dentre estas podem ser citadas as fissuras labiopalatinas. Ocorrem devido à mal formações congênitas e comprometem o desenvolvimento orofacial e maxilo-mandibular, gerando complicações estéticas e funcionais. O momento para abordagem cirúrgica em pacientes com deformidade deste tipo é crucial para atingir o melhor resultado. Entretanto, muitos deles não procuram atendimento ou não tem acesso aos centros especializados. A pré-maxila em portadores de fissura labiopalatina transforame bilateral, não submetidos a tratamento cirúrgico na infância, é comumente protruída, impedindo o desenvolvimento e função adequada da musculatura perioral/ Ainda, pode causar dificuldades alimentares,de fonação e, principalmente, estético. O objetivo do presente trabalho é relatar o caso de uma paciente acompanhada no serviço de cirurgia bucomaxilofacial OSID/UFBA, portadora de fissura labiopalatina, submetida à remoção de pré-maxila em idade adulta. O fechamento da fenda palatina não foi possível devido a idade da paciente e o grau de desenvolvimento do palato, tendo indicado tratamento com uso de prótese obturadora. Considera-se que quanto mais precoce e associado a uma boa técnica cirúrgica forem realizadas as intervenções primárias, menores serão as sequelas. Consequentemente, os resultados estéticos e funcionais serão mais prováveis, sendo desnecessária a remoção cirúrgica da pre-maxila(AU)

Several craniofacial anomalies affect humans and, among these, it can be cited the cleft lip and palate. These occur due to congenital malformations and compromise the orofacial and maxillo-mandibular development, causing aesthetic and functional complications. The moment of the surgical approach in patients with this type of deformities is crucial to achieve the best outcome, however, many of them do not seek care or have no access to specialized centers. The premaxilla in carries of bilateral cleft lip and palate when they are not submitted to a surgical treatment in childhood, is commonly protruding, impeding the development and function of the perioral musculature, besides difficult feeding, phonation and mainly aesthetic. The aim of this article is to report the case of a patient accompained with the Bucomaxillofacial Surgery Service from OSID / UFBA, with cleft lip and palate, submitted to pre-maxilla removal, in adulthood. The cleft palate closure was not possible due to the age of the patient and degree of development of the palate, indicating treatment with obturator prosthesis. It is considered that, the sooner and associated with a good surgical technique, primary interventions are performed, the fewer the sequelae and consequently the aesthetic and functional results, where, in most cases, surgical removal of the premaxilla will be unnecessary(AU)

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Peripheral dentinogenic ghost cell tumor (DGCT) is a rare and non-aggressive benign odontogenic tumor. They usually affect the elderly and are predominantly located in the anterior region of the jaws. Their differential diagnosis includes reactive/inflammatory gingival lesions. We report here two cases of peripheral DGCT in a 73-year-old female and a 48-year-old male patient and review the cases published in the literature. Both lesions presented as a nodular lesion in the mandible, and panoramic radiography showed no abnormalities. Microscopically, it was observed to be an ameloblastomatous epithelial proliferation associated with clusters of ghost cells and dysplastic dentin. Immunohistochemistry revealed positivity for cytokeratin 19 and a low Ki-67 proliferative index. Based on histopathological features and the absence of radiographic findings, a diagnosis of peripheral DGCT was rendered. The low number of cases published of peripheral DGCT makes case reports important in providing information that helps in their diagnoses and management.

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Introdução: O sialolito é a patologia mais frequente nas glândulas salivares maiores, ocorrendo em maior prevalência na glândula submandibular. Os sinais e sintomas clínicos incluem edema e dor na região da glândula acometida pelo sialolito e em caso de obstrução do ducto, os sintomas são mais pronunciados. Existem diversas alternativas de tratamento para a sialolitíase, com indicações específicas de acordo com cada caso. Desse modo, o objetivo desse artigo é relatar a técnica cirúrgica utilizada para remover um grande sialolito localizado no parênquima de glândula salivar maior. Relato de Caso: Paciente do sexo feminino, 49 anos, melanoderma, com queixas álgicas à palpação da região submandibular direita, há aproximadamente oito meses, apresentando discreto aumento de volume enrijecido no local. Ao exame de imagem foi observada imagem radiopaca na região, sugerindo a presença de sialollito no interior da glândula submandibular direita. Conclusão: Diversas modalidades de tratamento são descritas para sialolitíase. O tratamento conservador e/ou minimamente invasivo está indicado para cálculos de pequena dimensão ou extraglandulares e inclui a ordenha da glândula afetada. Cálculos maiores, localizados no interior da glândula, requerem tratamentos mais radicais, e na maioria das vezes, a excisão cirúrgica da glândula é o tratamento de escolha.

Introduction: Sialolith is the most frequent pathology in the major salivary glands, occurring in greater prevalence in the submandibular gland. Clinical signs and symptoms include swelling and pain in the region of the compromised gland by the sialolith and in case of duct obstruction, the symptoms are more evident. There are several treatment alternatives for sialolithiasis, with specific indications according to each case. Thus, the aim of this article is to report the surgical technique used to remove a large sialolith located in the greater salivary gland parenchyma. Case Report: Female patient, 49 years old, black, with complaints of pain on palpation of the right submandibular region, for approximately eight months, with a slight increase in the hardened volume at the site. The imaging exam showed a radiopaque image in the region, suggesting the presence of sialolith in the right submandibular gland. Conclusion: Several treatment modalities are described for sialolithiasis. Conservative and/or minimally invasive treatment is indicated for small or extraglandular calcifications and includes milking of the compromise gland. Larger stones, located inside the gland, require more radical treatments, and most of the time, surgical excision of the gland is the treatment of choice.

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A displasia cemento-óssea florida (DCOF) é uma condição não neoplásica, esclerosante limitada aos ossos maxilares, relacionada ao osso do processo alveolar e, na maioria dos casos envolvendo bilateralmente a mandíbula. É uma condição rara que se apresenta nos maxilares, de forma autolimitante, evoluindo de um estágio osteolítico para osteoblástico, com prevalência pelo gênero feminino, de meia idade a idosas, melanoderma. Dessa forma, o objetivo do trabalho é relatar o caso clínico de uma paciente portadora de displasia cemento-óssea florida apresentando osteomielite local após exodontia.Paciente de 57 anos de idade, melanoderma, compareceu ao ambulatório do Hospital Manoel Victorino (Salvador, BA) do serviço de Cirurgia e Traumatologia Bucomaxilofacial, referindo histórico de exodontia do dente 47 há aproximadamente 02 anos, sem cicatrização local e presença de supuração e odor fétido. Ao exame intrabucal notou- se a presença fístula na região do dente 47 com secreção purulenta espontânea e presença de tecido necrótico. Ao exame de imagem (radiografia panorâmica), foi observado presença de lesões radiopacas multifocais das áreas posteriores mandibulares. Foi submetida a cirurgia, sob anestesia geral, para curetagem de sequestro ósseo e fechamento primário do defeito por primeira intenção e acompanhamento. O objetivo do trabalho foi relatar um caso clínico de um sequestro ósseo mandibular em uma paciente com displasia cemento- óssea florida(AU)

Flowery cementum-bone dysplasia (DCOF) is a non-neoplastic, sclerosing condition limited to maxillary bones, related to the alveolar process bone and, in most cases, bilaterally involving the mandible. When infected can lead to suppuration and kidnapping, resulting in a picture of osteomyelitis. It is a rare condition that occurs in the jaws, in a selflimiting way, evolving from an osteolytic stage to osteoblastic, with prevalence by the female gender, from middle age to the elderly, melanoderma. Therefore, the aim of this paper is to report a diagnosed case of florid cemento-ousseous dysplasia, presenting local osteomyelitis after a extraction. Patient 57 years old, melanoderma, attended the outpatient clinic of the Hospital Manoel Victorino (Salvador, BA) of the Bucomaxillofacial surgery and traumatology department, referring to a history of the right mandible exodontia for approximately 2 years, without local scarring and presence of odor and suppuration fetid The intraoral examination revealed the presence of a fistula in the region distal to the tooth 47 with spontaneous purulent secretion and necrotic tissue. At the imaging examination (panoramic radiography), the presence of multifocal radiopaque lesions of the mandibular posterior areas was observed. She underwent surgery under general anesthesia for curettage of bone sequestration and primary closure of the defect by first intention and follow-up. The objective of this study was to report a clinical case of a mandibular bone sequestration in a patient with florid cementoosseous dysplasia(AU)

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Infecções maxilo-faciais graves são caracterizadas pela disseminação do processo infeccioso aos tecidos adjacentes e espaços fasciais da região de cabeça, pescoço e tórax. Sua principal origem é odontogênica, geralmente resultante de infecção periapical e doença periodontal. Podem variar de infecções bem localizadas de baixa severidade, até infecções graves, com potencial de disseminação para espaços fasciais da cabeça e pescoço, podendo causar o comprometimento de estruturas vitais, septicemia e morte. Essas infecções podem atingir diversos espaços, dentre eles o espaço mastigatório, composto pelos espaços fasciais: submassetérico, pterigomandibular, temporal profundo e temporal superficial. Esses quatro compartimentos do espaço mastigatório, comportamse clinicamente como espaços separados, pois, na maioria dos casos, somente um compartimento torna-se infectado, entretanto, infecções severas ou duradouras podem envolver todos os quatro compartimentos. O objetivo do presente estudo é apresentar o manejo clínico e cirúrgico de infecção odontogênica disseminada para o espaço temporal superficial. Paciente de 51 anos de idade, do sexo feminino, com histórico de infecção odontogênica disseminada para o espaço temporal superficial, tendo como fator etiológico resto radicular da unidade 13. Procedeu-se drenagem ambulatorial do conteúdo associada à antibioticoterapia. Após o período de 07 dias, houve remissão da condição. Apesar de incomum, infecções odontogênicas originadas de dentes anteriores, podem se disseminar para os espaços mastigatórios. Independente de sua origem deve ser tratada de forma imediata, drenando o espaço comprometido, identificando a causa e eliminando-a, e associando o uso de antibióticos como coadjuvante(AU)

Severe maxillofacial infections are characterized by the spread of the infectious process to adjacent tissues and fascial spaces of the head, neck and chest region. Its main origin is odontogenic, usually resulting from periapical infection and periodontal disease. It can range from well-localized infections of low severity to severe infections with potential for dissemination to spread through the facial planes of the head and neck, which can lead to compromised airways, resulting in septicemia and death. These infections can reach several spaces, among them the masticatory space, composed of fascial spaces: subassayeric, pterygomandibular, deep temporal and superficial temporal. These four compartments of the masticatory space behave clinically as separate spaces, since in most cases only one compartment becomes infected, however, severe or long-lasting infections may involve all four compartments. The goal of the present study is to present the clinical management of disseminated odontogenic infection for superficial temporal space. A 51-year-old female patient with a history of odontogenic infection, disseminated to the superficial temporal space, having as the etiological factor the root rest of unit 13. Outpatient drainage of contents and antibiotic therapy-associated was performed. After the period of 07 days, there was remission of the condition. Although uncommon, odontogenic infections originating from anterior teeth may spread to masticatory spaces. Regardless of its origin, it must be treated immediately, draining the compromised space, identifying the cause and eliminating it, and associating the use of antibiotics as a coadjuvante(AU)

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OBJECTIVE: This study seeks to investigate immunohistochemical parameters that could distinguish non-aggressive Central giant cell granuloma (CGCG) from aggressive CGCG, two groups of lesions which differ in their clinical and radiographic features and prognosis. MATERIAL AND METHODS: 12 cases of non-aggressive CGCG and 11 cases of aggressive CGCG were investigated and associated the immunohistochemical expression of macrophages (CD68 and CD163), blood vessels (CD34 and CD105), lymphatic vessels (D2-40) and regulator proteins (p63 and Ki-67). Clinical and radiographic features were also studied. RESULTS: Associations between all proteins in non-aggressive and aggressive CGCG were not significant (p > 0.05). With respect to non-aggressive CGCG, there were no significant correlations, while in aggressive CGCG there was a significant positive correlation between CD68 and CD163 (p = 0.031), between CD34 and D2-40 proteins (p = 0.04), whereas a significant negative correlation was observed between CD105 and CD68 (p = 0.040). However, regardless of aggressiveness of CGCG, there was a significant positive correlation between CD68 and CD163 (p = 0,04). Among the clinical and immunohistochemical aspects, only the symptomatology was a significant risk factor for the occurrence of aggressive CGCG (OR = 12.00/p = 0.016). CONCLUSION: Macrophages and angiogenesis contribute to their maintenance and development of CGCG. In addition, immunohistochemistry used here was not able to differentiate their aggressiveness. However, symptomatology was proved to be a risk factor for the occurrence of aggressive CGCG. It is possible that clinical features, particularly symptomatology, represent the most appropriate parameter to attempt to distinguish GCCG.

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As fissuras labiopalatais são malformações congênitas faciais resultantes da falha no mecanismo de fusão dos processos frontonasais laterais com os processos mediais maxilares entre a oitava e a décima segunda semana de vida intrauterina, apresentando uma etiologia multifatorial. O presente estudo teve como objetivo apresentar a utilização de um retalho miomucoso de língua para o tratamento de fístula complexa em palato duro, secundária ao insucesso de uma palatoplastia primária. Paciente do sexo masculino, 15 anos de idade, portador de fissura labial bilateral transforame, apresentou-se ao Hospital Santo Antônio das Obras Sociais Irmã Dulce para tratamento de fístula em região de palato. Após preparo pré-operatório, o paciente foi submetido a procedimento cirúrgico, sob anestesia geral, para fechamento da fístula utilizando-se um retalho pediculado de língua com base na porção anterior da mesma. O retalho foi mantido pediculado cerca de 01 mês, período imprescindível para integração do enxerto na área receptora. Após esse período, realizou-se novo procedimento para soltar o pedículo e moldar o enxerto de tecido mole ao palato. Observou-se no pós-operatório da segunda intervenção, boa integração do enxerto de língua ao palato, fechamento da fístula palatina, permanecendo apenas um pequeno orifício residual comunicando com a cavidade nasal. Constatou-se ainda melhora de funções como dicção das palavras, deglutição e do som anasalado da fala do paciente, e, consequentemente, da sua qualidade de vida. A técnica mostrou-se uma opção efetiva para a reabilitação das grandes fístulas palatinas e exige uma atuação interdisciplinar para execução do protocolo de tratamento(AU)

The labiopalatal fissures are congenital facial badly formations resulting from the failure of the fusion mechanism of the lateral frontonasal processes with the maxillary medial processes between the eighth and tenth week of intrauterine life, presenting a multifactorial etiology. The present study aimed to present the use of a tongue myomucosal flap for the treatment of complex fistula in the hard palate, secondary to the failure of a primary palatoplasty. A 15-year-old male patient with transforame bilateral cleft lip, presented to Hospital Santo Antônio das Obras Sociais Irmã Dulce for treatment of fistula in the palate region. After preoperative preparation, the patient underwent a surgical procedure, under general anesthesia, to close the fistula using a pedicled tongue flap based on the anterior portion of the same. The flap was kept pediculated around 30 days, an essential period for graft integration in the recipient area. After this period, a new procedure was accomplished to drop the pedicle and to shape the soft tissue graft to the palate. In the second intervention, postoperative period, a good integration of the tongue graft to the palate was observed, closing the palatine fistula, remaining only a small residual orifice communicating with the nasal cavity. There was also an improvement in functions such as word diction, swallowing, and the patient's speech nasal sound. The technique proved to be an effective option for the closure of the large palatine fistulas, providing an excellent rehabilitation and, consequently, an improvement in the patient's quality of life(AU)

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